‘Breaking point’: fears over lack of intensive care beds for children

This article was taken from: https://www.theguardian.com/society/2019/dec/29/nhs-picu-shortage-intensive-care-beds-critically-ill-children

By Denis Campbell Health policy editor

Exclusive: critically ill children rushed to units across England as NHS struggles to find beds

Critically ill children are being rushed from one part of England to another because NHS hospitals are running short of intensive care beds in which to treat them, the Guardian can reveal.

An increase in severe breathing problems in children driven by winter viruses and infections, including flu, means some are having to be transferred sometimes many miles from their home area because there are not enough paediatric intensive care (PICU) beds locally.

Specialist doctors who staff the units say the situation is “dangerous and rotten for the families” involved and that staff are firefighting to handle the number of children needing sometimes life-saving care, many of whom are on a ventilator to help them breathe.

In the past few weeks, young patients have been sent from the Midlands to Sheffield, from London to Cambridge, and from one side of the Pennines to the other in order to get them a place in a PICU.

One doctor at a PICU in the Midlands said: “PICU beds are always in high demand. But since winter hit this year, around six weeks ago, the situation feels like we are simply firefighting. Many days I come on shift to find there are no beds in [our] region and the patients referred to us end up in Southampton, Sheffield, Oxford and other centres far away.

“The PICU network is overstretched. There aren’t enough beds, nurses or skilled doctors.”

A PICU doctor in London said: “This winter has so far been mild and yet pressure on beds from children with respiratory disease or respiratory vulnerability seems recognisably worse than previous years.

“We have no beds to accept patients with invasive pneumonia who need surgical resource, and we are stepping children down from intensive care to the main wards earlier than we would like to make way for the relentless influx of newer, sicker patients. The system is at breaking point.”

A consultant at another major London hospital said: “At one point over a weekend in December there were 11 intubated newborns or babies awaiting PICU beds, with none available anywhere. One of our patients went to Cambridge and another two were transferred out of London too. [This is] dangerous and rotten for the families.”

Addenbrooke’s hospital in Cambridge said on 23 December: “So far this month we have been able to accommodate 32 transfers into our paediatric intensive care unit and paediatric high dependency units, of which four would normally go to London hospitals.”

A message sent between PICU doctors in the capital on 17 December said: “There are no PICU beds in London and three ventilated patients awaiting a bed across London.”

Another message shared by PICU doctors on 20 December, seeking a bed for a child at Whipps Cross hospital in London with bronchiolitis, showed that there were no beds at St George’s or King’s College hospitals in south London or in the NHS’s entire North Thames region, which covers east, central and north London and Cambridge.

Dr Peter-Marc Fortune, the president of the Paediatric Intensive Care Society, confirmed that early winter circulation of bugs was leading to children being transferred.

“At this time of year things are always very, very busy. We run right at the edge of capacity every year. Everyone feels very buried and that they are working to their limit,” he said.

Dr Julia Patterson, a spokeswoman for EveryDoctor, a network of grassroots NHS doctors, said: “Paediatric intensive care exists to treat some of the most vulnerable members of our society. After nine years of planned NHS austerity cuts by the government, it is not surprising that the end-point is a lack of safe care for the most vulnerable. But it is a situation which is utterly shocking and totally unacceptable to the UK doctors at the frontline, caring for these patients every day, and we are therefore moved to speak up.

“This situation is being allowed to happen by politicians who have the power to inject emergency funds and turn the situation around. Sick children’s lives are at risk. How can we call ourselves a civilised society when our children’s lives are being wantonly placed at risk?”

Disclosure of the acute shortages of PICU beds comes after intensive care doctors said that pressure on beds in the units where they work is worse than official NHS figures show.

In an unusual move, the Faculty of Intensive Care Medicine (FICM) raised concerns about the accuracy of official NHS “sitreps” data. The figures, published weekly by NHS England during winter, detail bed occupancy across the country in intensive care units for adults, paediatric intensive care units for children and neonatal intensive care units for newborns.

The most recent data, showing that units in England had been on average 83% full so far this winter, were deceptive and underestimated the true extent of the pressures being felt, the FICM said.

Dr Alison Pittard, the FICM’s dean, told the Health Service Journal that many units had been 100% full in December and that its members were concerned that one in four hospitals “did not recognise their unit’s sitreps data”. NHS England did not respond in detail to the claims but said the figures were submitted by hospitals themselves.

It emerged last month that the number of hospital beds available in England has fallen to its lowest ever level because 17,230 beds have been cut since 2010. Many hospitals have opened extra beds to help them cope this winter.

In other evidence of the mounting pressures winter is putting on NHS services:

• The Countess of Chester hospital in Chester has installed three portable buildings in its grounds and is using them as temporary “modular wards” to give it extra capacity to treat patients.
• Leicester Royal Infirmary has opened a nine-bed “interim ambulance handover facility” in a portable building in which patients who are not seriously ill are looked after rather than having to stay with East Midlands ambulance service personnel until A&E staff can accept them.
• In an unusual move, the East of England ambulance service recently asked its staff if they would work in the A&E units of hospitals in Norwich, King’s Lynn and Gorleston.
• The Guardian revealed recently that the Norwich and Norfolk hospital in Norwich had come under such strain that doctors had been told to use “the least unsafe option” when treating patients. It later said the “hastily worded email” was sent when it was “under extreme pressure”.

An NHS spokesperson said: “Seasonal increases in respiratory illness and other conditions mean there is often higher demand for paediatric intensive care during the Christmas and winter period and as the NHS responds to this extra demand, it is regular practice for local services to work together to provide safe, appropriate and timely care to families.”