Dear Councillors
Invite Critical Beds Campaign visit to 10 Downing Street midday on 12th July
To those of you who are newly elected I have been part of a team campaigning for King George A&E for years. Back in 2014 we organised a visit to 10 Downing Street per the link below:
I write today to seek your support for a campaign to extend critical care bed provision at both Queens and King George Hospital. This email goes into detail into why the campaign is reasonable. It also explains why the BHRUT claim that our residents have sufficient critical care beds does not stand scrutiny. The reality is NHS evidence shows a deterioration in cancelled operations at BHRUT linked to insufficient critical care beds. For years BHRUT claimed it was safe to close King George A&E , a process that is now under “review” since November 2017. Our job is to use the evidence below to persuade BHRUT and the government as to why we need more life saving critical care beds for our residents. Perhaps the first step is for BHRUT to commission a review, similar to that of the review into the King George A&E closure, into how many extra critical care beds are needed to cope with the 2018/19 winter.
The below quote is from the CQC on 2nd July 2015 about Critical Care Beds at King George Hospital.
“There were insufficient critical care beds available for the population served by the Barking, Havering and Redbridge University Hospitals NHS Trust in comparison with other London trusts. Capacity was high at an average of 95%. It was estimated that critical care bed shortages affected 100 to 200 patients across the trust each month, with patients experiencing cancellations of planned procedures and significant waits in A&E (or in the recovery unit) while waiting for ITU beds.” (my emphasis)
The quote below is from the CQC on 2nd July 2015 about Critical Care Beds at Queens Hospital.
“There were insufficient critical care beds available for the population served by the trust in comparison with other London Trusts. Despite four additional beds being made available, capacity has remained high at an average of 95%. It was estimated that critical care bed shortages affect 100-200 patients each month, with cancellation of planned procedures and significant waits in A&E when waiting for a GICU bed.”
The CQC into BHRUT published in June 2018 does not seem to have investigated critical care and instead refers to the 2015 report.
The BBC tracker 4 hour A&E tracker for today states BHRUT is ranked 112 out of 133 trusts in May 2018.
A BHRUT email sent to me yesterday says:
We opened 6 additional critical care beds in 2017. The occupancy was around 99-100% across the winter months, as is expected, and, in addition, we opened a 9 bedded surgical step down unit. We flex this total bed capacity to ensure there is flow through the critical care unit. This enables us to move patients to the correct level of care as their condition improves which frees up the higher intensity care beds to admit the sicker patients into as need arises. (my emphasis)
In 2015 the CQC termed a critical bed occupancy high at 95%. The BHRUT email above shows shows a deterioration in critical care bed availability with an occupancy rate of 99-100%:
The CQC did not find a critical care bed occupancy rate of 95% as acceptable in 2015, a higher rate of “99%-100%” is unacceptable in 2018.
The NHS statistics show a worse position for cancelled operations since 2015 when BHRUT was in special measures
Number of last minute elective operations cancelled for non clinical reasons for January to March 2015 was 155 (1)
Number of patients not treated within 28 days of last minute elective cancellation for January to March 2015 was 15 (1)
The figures below show the deterioration taking place by 2018
Number of last minute elective operations cancelled for non clinical reasons for January to March 2018 was 187 an increase of 32 (2)
Number of patients not treated within 28 days of last minute elective cancellation January to March 2018 was 28 an increase of 13. (2)
Operations are not the only purpose of a critical care bed. When in a King George consulting room in December 2018. I had two fits and my Glasgow coma score dropped. As a consequence I was transferred to one of the 8 King George Critical Care beds put into a medical coma and given mechanical ventilation. This rapid care may have improved my recovery from a stroke. Contingency plans will exist for when no critical care beds are available for stroke and other types of patient who need critical care care, but they must be second best. No statistics appear to be kept for how many stroke and other types of seriously ill patients, although not requiring an operation, are denied a critical care bed each month.
King George looked after me until I was stable enough to be transferred to Queens stroke unit. Care for which I will be forever grateful.
Transferring patients from King George to Queens on days when King George Critical beds are full up is second best and must also put pressure on Queens.
A June 2018 Health Service Journal report said that “Bed shortages cause dangerous delays in cranial neurosurgery, Getting It Right First Time Report finds” (3) The journal relies upon a NHS June 2018 report into Cranial Neurosurgery which requires critical care beds. (4)
The BHRUT website says
“Queens Hospital is the main neurosurgical referral centre for North East London and Essex. We have a helicopter landing pad, and accept neuro trauma patients from Essex, Kent and London Helicopter Emergency Medical Service.” (5)
I have copied BHRUT in for your comment that may wish to make.
I attended a Redbridge Health and Well Being Board earlier per the recording here to raise the issue around 6 minutes in:
Cllr Ryan is interested to know if patients has put at risk of harm as a consequence of critical care beds being full up (I paraphrase)
Dr Mehta, the Chair of Redbridge Clinical Commissioning Group said he would look “into the matter” at around 8 minutes into the recording. Following the deterioration in performance outlined by BHRUT above since the 2015 CQC report it seems reasonable to expect Dr Metha will find patients have been put at increased risk of harm since 2015
As well as the neurosurgical issue, the prospects of surviving emergency Laparotomies appear to improve if a critical care bed is available (6,7,8)
The BHRUT board presentation (7) is very clear about the need to avoid 100% critical care bed capacity: I quote from the presentation.
“By 2014 it became obvious, that General Critical Care required urgent increase in capacity
• Most months bed occupancy rates exceed 100%”
An increase in critical care beds in BHRUT has taken place since 2015, but it has not been enough to cope with our growing population. I stress again the catchment area for some of these beds includes North East London, Essex and Kent.
Critical Care Bed numbers are increasing – it is reasonable to ask for more to cope with your growing population.
- I quote from a Kings Fund Report into NHS bed numbers
- Critical care beds
The NHS maintains critical care beds for patients who are seriously ill and require constant support. These are measured on a different basis to other beds described in this section.1 Unlike most other categories of hospital bed, the total number of critical care beds has increased in recent years. In 2011/12 there were around 5,400 critical care beds, by 2016/17 this had risen to 5,912 – an increase of around 9.5 per cent (NHS England 2017b).2 Of these, around 68 per cent are for use by adults and the remainder for children and infants.
A recent government review of critical care services showed substantial variation in the number of critical care beds maintained per 100,000 of population across advanced health systems (Monitor 2014, p 17). In a comparison of eight advanced European systems, the UK was shown to maintain the joint second-lowest number of critical care beds relative to the population (Bittner et al 2013).3
ENDs
Further information about the strain on Critical Care beds are at
I hope very much that Barking and Dagenham will join with Havering Redbridge and send a representative/s to 10 Downing Street on the 12th July to seek funding for more critical care beds for King George & Queens Hospitals to cope with the 2018/19 winter.
Regards
Andy Walker
120 Blythswood Road
IG3 8SG
(1)& (2) are listed at https://www.england.nhs.uk/statistics/statistical-work-areas/cancelled-elective-operations/cancelled-ops-data/ (1) is at https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2018/05/QMCO-Cancelled-Operations-Q4-2017-18.csv& (2) is at https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2013/04/Q4-2014-15-Cancelled-Ops-25555.xlsx
7) BHRUT presentation on critical care at https://redbridgetradeunionparty.files.wordpress.com/2018/05/critical-care-bedspdf.pdf
9) Kings Fund report of NHS Bed Numbers dated September 2017.
https://www.kingsfund.org.uk/publications/nhs-hospital-bed-numbers
10) CRITICAL CAPACITY A SHORT RESEARCH SURVEY ON CRITICAL CARE BED CAPACITY by the The Faculty of Intensive Care Medicine at
https://www.ficm.ac.uk/sites/default/files/ficm_critical_capacity_-_a_short_research_survey_on_critical_care_bed_capacity.pdf
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