NHS Intensive care units, which have played a vital role in the Covid-19 crisis, are routinely understaffed, with patients at risk of poor care, as the doctors working in them warn today.
Four in five intensive care consultants believe the shortage of doctors and nurses has left their unit too “stressful” to provide the best possible treatment for people receiving life or death care.
The unprecedented demands placed by Covid on ICU staff mean that one in seven of the NHS’s 2,500 intensive care counselors is considering quitting smoking or switching to another role amid widespread stress and fatigue among doctors who have borne the brunt of the pandemic.
The College of Intensive Care Medicine (FICM) said the findings of a UK-wide survey that it conducted last month of top ICU physicians and shared it with the Guardian, showed that an ICU understaffing is alarmingly common.
Sixty percent of units have nursing vacancies and 40% of units are forced to close beds on a weekly basis due to lack of staff. “So it’s a pervasive problem,” said Dr. Alison Pittard, the dean of the college, who represents the intensive care staff.
She added that the units’ inability to cope with a staff shortage to maintain a 1: 1 nurse / patient ratio considered essential for safe patient care was a concern.
There is evidence to suggest links between nursing resources and patient outcomes and adverse events. Therefore any dilution of critical care experience could have a negative impact on patient outcomes and this undoubtedly leads to stress among staff, “Pittard said.
At the height of the epidemic in April, intensive care units across the UK were caring for nearly 4,000 patients. The second increase left 16,145 people in hospital, of whom 1,422 were in the intensive care unit. Doctors say this percentage is lower than in the first wave because fewer people are now undergoing mechanical ventilation because other forms of treatment have been found to be more effective.
One ICU consultant who participated in the survey said, “There are not enough consultants and ICU nurses. We need to increase the workforce significantly in the near future to have any chance of dealing with the increases in the future.
“We simply don’t have enough ICU beds. There is a dire need for a massive expansion campaign with a maximum of 80% of these beds occupied in the future. Our benchmark before Covid was more than 100% occupancy most of the time – a recipe for disaster.”
The FICM survey also found that while 45% of ICU consultants said their units had permanently expanded capacity after dealing with the first wave of Covid in the spring, only 18% said the additional beds created were staffed with enough staff.
The college also found that:
ICU doctors say hospitals will again have to cancel non-urgent surgery again during the second wave, as they did in the spring, so that anesthesiologists and other staff can help in the ICUs.
The survey found that the unparalleled stress caused by the epidemic has left many ICU doctors suffering from stress, exhaustion, and in some cases, problems with their relationships and family lives. Most (88%) of their vacation was canceled and worked longer hours (80%) to help the units acclimate.
“A lot of people have been hit but few have been broken,” said Dr. Jack Barry Jones, Head of Manpower at FICM.
Another ICU consultant said: “The mental loss of this pattern of work and the mortality and morbidity associated with increased ICU work will seriously affect my mental and physical health. I was already very restless in the first wave and I fear the second wave.”
Nicky Creedland, president of the British Association of Critical Care Nurses (BACCN), which represents ICU nurses, said she shares Pittard’s concern that staffing is threatening patient care.
“While the survey results make reading difficult, I am unfortunately not surprised. Critical care units, like the rest of the NHS, are unfortunately underfunded with a significant shortage of nursing and medical staff. There is simply no laxity in the system which is seeing an increase in numbers. Patients lonely year after year.
“When this pandemic hit us, we saw major problems related to employee sickness, morale, personal and psychological health. The NHS works on the goodwill and dedication of its staff. This is simply not sustainable in the long term.”
NHS England and BACCN recently agreed that nurses in intensive care units in England could care for two Covid patients at the same time during the second wave.
Pittard said the pressure of too little staff on ICU staff is also making it difficult to recruit and retain staff.
An NHS spokesperson said: “Despite the rise in critical care beds in recent years and the number of senior intensive care physicians doubling, Covid has shone great light on the vital and incredibly demanding work of these amazing teams, which must undoubtedly receive continued support backed by more Expansion of the workforce in the coming months and years.