January 29, 2014
Contact: Harlow Labour
(01279) 625870

Critical Care Bed Shortage at PAH

Analysis shows Princess Alexandra Hospital regularly running out of critical care beds

New analysis by Labour shows that Princess Alexandra Hospital in Harlow had no available critical care beds on 31 out of 80 days between the 4th of November 2013 and the 22nd of January 2014 because all of them were full. Over that period 5 potentially life-saving urgent operations had to be cancelled at the hospital.

Critical care beds are reserved for some of the most seriously ill patients, patients who are suffering from organ failure or who have been involved in a serious accident. If none are available then desperately sick patients could be forced to travel miles to another hospital, while others who needed life and limb-saving procedures would have to endure risky delays.

This revelation comes as the NHS is facing up to a winter crisis thanks to David Cameron. The latest figures from the service reveal that the NHS has just had its worst week so far for A&E performance.

Suzy Stride, Labour’s General Election candidate for Harlow said:

It is extremely worrying that on so many days there were no spare beds available for critically ill patients in Harlow. This is a clear sign of a system in distress and a crisis in emergency care that is getting more serious by the day.

Ministers must provide an urgent reassurance to the people served by Princess Alexandra Hospital that there are sufficient critical care beds in place to cope with pressure throughout the rest of this winter. We also need to know whether patient safety has been compromised in any way and whether any critically ill patients faced unacceptably long waits to receive care.

The fault here clearly lies with this Tory government. Anyone looking at these figures will conclude that the NHS is simply not safe in this government’s hands."

 ENDS

 

Notes to editors

  • The number of Adult Critical Care Beds ‘available’ and ‘occupied’ on each day is recorded, as part of the Department of Health’s NHS Winter Monitoring.
  • Figures on critical care bed shortages have been calculated by subtracting the number of ‘occupied beds’ from the number of ‘available beds’. The winter period for 2013/14 covers 04/11/2013 to 22/01/2014 (80 days) total.
  • The table below shows the number of hospitals that have run out of adult critical care beds each day. January 20thwas the worst day so far, when 50 hospitals ran out of adult critical care beds:

 

 

18-Nov-13

19-Nov-13

20-Nov-13

21-Nov-13

22nd to 24thNov 13*

25-Nov-13

26-Nov-13

27-Nov-13

28-Nov-13

29thNov 2013 to1st Dec 2013*

25

25

24

32

26

29

24

30

25

24

02-Dec-13

03-Dec-13

04-Dec-13

05-Dec-13

6th to the 8thDec 13*

09-Dec-13

10-Dec-13

11-Dec-13

12-Dec-13

13th to 15thDec 13*

35

34

27

36

24

35

38

30

29

22

16-Dec-13

17-Dec-13

18-Dec-13

19-Dec-13

20th to 22ndDec 13*

23-Dec-13

24th to 26thDec-13*

27th to 29thDec-13*

30-Dec-13

31stDec 13 to 1stJan 14*

34

41

31

29

21

22

20

28

33

34

02-Jan-14

3rd to 5thJan 14

06-Jan-14

07-Jan-14

08-Jan-14

09-Jan-14

10th to 12th Jan 14

13-Jan-14

14-Jan-14

15-Jan-14

33

31

36

43

36

34

30

42

34

35

16-Jan-14

17-19-Jan-14

20-Jan-14

21-Jan-14

22-Jan-14

 

 

 

 

 

39

32

50

47

37

 

 

 

 

 

Source: Winter Pressures Daily SitRep 2013-14 Data, http://www.england.nhs.uk/statistics/statistical-work-areas/winter-daily-sitreps/winter-pressures-daily-sitrep-2013-14-data-2/

 (*For figures which cover multiple days  we have assumed the number of hospitals without spare beds has remained constant across the time period given and this has been used in calculating the average e.g. we have assumed that the on the 22nd, 23rdand 24th of November the number of hospitals each day was 26.)

  • Adult critical care beds are for people who require intensive care or are in a serious medical condition. They are for patients defined as level 2 and 3 by the NHS:

Level 2 patients - requiring more detailed observation or intervention including support for a single failing organ system or post-operative care and those 'stepping down' from higher levels of care.)

Level 3 patients - requiring advanced respiratory support alone or monitoring and support for two or more organ systems. This level includes all complex patients requiring support for multi-organ failure.

NHS Data Dictionary, http://www.datadictionary.nhs.uk/data_dictionary/attributes/c/cou/critical_care_level_de.asp?shownav=1

  • Critical care patients often require intense support, treatment and monitoring. Critical care beds are often found in Intensive Care Units and High Dependency Units:

“Intensive care units (ICUs) are specialist hospital wards. They provide intensive care (treatment and monitoring) for people in a critically ill or unstable condition. ICUs are also sometimes known as critical care units or intensive therapy departments. A person in an ICU needs constant medical attention and support to keep their body functioning. They may be unable to breathe on their own and have multiple organ failure. Medical equipment will take the place of these functions while the person recovers.”

NHS Choices, http://www.nhs.uk/Conditions/Intensive-care/Pages/Introduction.aspx

  • Intensive care is for people who have major organ failure, for example failure of the lungs, kidneys or digestive system. Patients can come through Accident & Emergency, for example, as a result of an emergency admission or ‘a serious accident – such as a road accident or a severe head injury’:

“Intensive care is often needed when one or more of your organ systems has failed. For example, this might be your – lungs, kidneys, heart, digestive system.

There are many different conditions and situations that can cause your organ systems to fail. Some of the most common include:

  • a serious accident – such as a road accident or a severe head injury
  • a serious acute (short-term) health condition – such as a heart attack (where the supply of blood to the heart is suddenly blocked), or a stroke (where the blood supply to the brain is interrupted)
  • a serious infection – such as a severe case of pneumonia (inflammation of the lungs) or sepsis (blood poisoning)
  • major surgery – this can either be a planned admission to an ICU as part of your recovery after surgery or an emergency measure if there are complications during surgery

 

 

 

http://www.nhs.uk/Conditions/Intensive-care/Pages/Why-is-it-necessary.aspx

 

  • A&E target for type 1 (hospital A&E) was missed for the 27th week in a row. 75 Trusts with a hospital A&E missed the 4 hour target

 Period

Percentage in 4 hours or less (type 1)

Percentage in 4 hours or less (all)

W/E 20/01/2013

93.8%

95.8%

W/E 19/01/2014

93.1%

95.4%

  

Impact on elective care

  • The President of the Royal College of Surgeons has previously warned that that A&E pressures are causing problems for people who require intensive care:

 “Norman Williams, president of the Royal College of Surgeons, said the pressures on A&E had now become “relentless” and were hampering patients’ access to emergency theatres and intensive care facilities.”

Telegraph, May 15 2013http://www.telegraph.co.uk/health/healthnews/10058125/AandE-crisis-hospital-casualty-units-under-huge-pressure-Jeremy-Hunt-admits.html

  • This is from the ‘Intensive Care Foundation’, who say that operations can be cancelled because of a lack of intensive care beds:
 “Sometimes operations are cancelled because of a lack of intensive care beds. Most intensive care units in Britain run at, or near, full capacity all the time. One of the very important jobs of the medical and nursing team on the intensive care unit is trying to work out each day who is able to return to the ward and which planned operations can go ahead. If your operation is cancelled, remember that the doctors and nurses are putting your safety first and it is likely that they had to admit an emergency patient despite trying to keep a bed for you.”
Intensive Care Foundation, http://www.ics.ac.uk/icf/patients-and-relatives/information/about-critical-care/admission/

·         The latest figures show that 250 urgent operations were cancelled in December -

 Year

Period

Urgent Operations Cancelled

2010-11

August

172

2010-11

December

322

2011-12

December

389

2012-13

December

220

2013-14

November

196

2013-14

December

250

 

·         Level 1, of the an ‘urgent operation’ are patients who are “Immediate - Immediate (A) life saving or (B) limb or organ saving intervention. Operation target time within minutes of decision to operate”, which fits in with the definition of patents who are on critical are wards:

 

Definition of “urgent operation”

The definition of 'urgent operation' is one that should be agreed locally in the light of clinical and patient need. However, it is recommended that the guidance as suggested by the National Confidential Enquiry into Perioperative Deaths (NCEPOD) should be followed. Broadly these are:

I.             Immediate - Immediate (A) life saving or (B) limb or organ saving intervention. Operation target time within minutes of decision to operate.

II.           Urgent – acute onset or deterioration of conditions that threaten life, limb or organ survival. Operation target time within hours of decision to operate.

III.         Expedited – stable patient requiring early intervention for a condition that is not an immediate threat to life, limb or organ survival. Operation target time within days of decision to operate.

IV.         Elective – Surgical procedure planned or booked in advance of routine admission to hospital

Monthly Trust SitReps, Definitions and guidance, Pg. 6

 ·         The National Audit office say that “The most critical and severe cases tend to arrive via ambulance”

 1.14 The most critical and severe cases tend to arrive via ambulance, with an A&E conversion rate of 51 per cent, more than three times higher than for patients who take themselves to major A&E departments. This means that hospitals with a higher proportion of patients arriving by ambulance are likely to admit more patients.

National Audit Office, Emergency admissions to hospital: managing the demand, 31 October 2013, Page 19

·         Rise in elderly patients arriving at A&E – Official NHS Hospital Episode Statistics[1] reveal a hugely disproportionate increase in the numbers of elderly people arriving at A&E in ambulances in the first two years of this Government. The most recent data, for the year 2011-12, shows a 66% increase in over 90 year olds arriving at A&E compared to Labour’s last year – an extra 110,000 patients. A&Es saw a 19% rise in attendances from over 80 years olds too – 121,000 patients.

 Age group

2009/10

2011/12

% change 2009/10 to 2011/12

0-9

273,207

263,687

-3.50%

10-11

346,527

278,557

-19.60%

20-29

413,346

449,675

8.80%

30-39

361,469

367,277

1.60%

40-49

404,799

435,371

7.60%

50-59

347,329

390,456

12.40%

60-69

395,486

435,698

10.20%

70-79

562,854

601,637

6.90%

80-89

635,834

757,555

19.10%

90+

165,910

275,883

66.30%

Unknown

18,158

1,088

 

Total

3,924,919

4,256,884

8.50%

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