NHS England: Hospitals must ‘surge’ ICU so other regions don’t have to ration care

A letter sent to dozens of acute trusts today by NHS England asks them to enact their “maximum surge” for critical care from tomorrow, opening up hundreds of beds, which will rely on them redeploying staff and cancelling more planned care.

The letter is to trusts in the Midlands but HSJ understands a similar approach is being taken in the other regions where critical care is not currently under as much pressure as London, the East of England and the South East.

The message to surge capacity to support a “national critical care service” was reinforced to trusts nationwide in a call with Keith Willett, NHS England covid incident director, also on Wednesday.

The letter, from the NHSE Midlands regional team, said there had been a national request for the region to surge beyond its own needs to support London and the East of England. “Significant” numbers are likely to be transferred, HSJ was told.

This was because, it said, those regions may breach their maximum ‘super surge’ capacity later this month. The letter indicates that this would leave clinicians in those areas having to make what are described as difficult triage decisions. This means denying access to critical care based on availability, not need. This cannot be allowed, the letter says.

It says transfers from the East and London will go to the largest Midlands trusts, while in turn they may transfer out to smaller trusts, and the region may transfer patients to Yorkshire and the North East. The letter says this networked approach will be the most resilient and share the burden. It may also keep travel distances lower, meaning the safety risk of transfers is less, it is understood.

Patients in the South East are mostly being transferred westwards into the central south and South West.

The letter, seen by HSJ, said the number of patients in intensive care units in the Midlands was 695 yesterday — higher than its April peak. 

Under maximum surge plans, the number of beds will be increased to 876, against the original baseline capacity of 632. According to the letter this should also allow the region to meet its own predicted demand up to 25 January.

Midlands trusts are already cancelling routine planned care, but HSJ understands some are now also postponing some “priority two” operations, which are urgent enough that they should take place between four and 20 days. Trust leaders were told by Professor Willett yesterday they were likely to need to cancel routine (priority three and four) electives, but try to protect P1 and P2.

’Super surge’ plans

All providers in the Midlands were asked this month to provide surge and super surge plans. ‘Super surge’ capacity is yet to be enacted. If and when it is, this would take critical care beds to 1,150.

Yesterday HSJ revealed plans by University Hospitals Birmingham FT to redeploy 200 doctors this week to help increase its intensive care capacity to 280.

The second largest trust in the Midlands, University Hospitals Leicester FT, will increase to 86 from a baseline of 62. Under a super surge plan the trust would increase to 120.

Super surge plans will mean the relaxing of critical care nursing ratios from 1:2 to 1:4.