Exclusive: Intensive care staffing ratios dramatically diluted

HSJ understands acute trusts in London have been told to base their staffing models for ICU on having one critical care nurse for every six patients, supported by two non-specialist nurses and two healthcare assistants. 

Under guidance from the Faculty of Intensive Care Medicine which applies at normal times, intensive care (also known as level three critical care) “requires a registered nurse/patient ratio of a minimum 1:1”.

Trusts have also been told by NHS England and NHS Improvement’s regional directorate to plan for one critical care consultant per 30 patients, supported by two middle grade doctors. The normal guidance is the consultant-to-patient ratio “should not exceed a range between 1:8-1:15”.

Nicki Credland, chair of the British Association of Critical Care Nurses, confirmed the plans had been agreed today nationally.

She told HSJ: “There will absolutely be a lot of concern about this in the profession, but it’s the only option we’ve got available. We simply don’t have the capacity to increase our staffing levels quickly enough.

“It will dilute the standard of care but that’s absolutely better than not having enough critical care staff. There’s also a massive issue around the ability of critical care nurses not only to care for their patients but also monitor what the non-specialists in their teams are doing.”

It comes as hospitals — especially in London — are starting to see a surge in patients suffering from coronavirus, and desperately trying to increase capacity. On Thursday last week, Northwick Park in Harrow had what was thought to be the first “critical incident” in relation to coronavirus.

While many covid-19 patients have minor illness, large proportions of those who are admitted to hospital require intensive care — and modelling suggests the NHS’ previous ICU capacity could fall far short. 

If more equipment such as mechanical ventilators are also made available, the new ratios might enable a huge increase in the NHS’ ability to staff newly created intensive care wards.

In the largest project HSJ is aware of so far, leaders in London are seeking to open thousands of new beds at a conference centre in east London.

Intensive care is for patients requiring advanced respiratory support, or basic respiratory support together with support of at least two organ systems. The NHS is also seeking to expand the number of beds where oxygen support short of mechanical ventilation can be given to covid-19 patients.

Alison Pittard, dean of the Faculty of Intensive Care Medicine, said the changes were the “only safe way to do it”. She added: “I welcome the guidance that’s been agreed that will allow healthcare professionals to continue to deliver high quality care in the safest possible way.”

NHSE and NHSI said in a statement: “NHS staff are working round the clock gearing up to deal with this unprecedented global health threat and, as the professional bodies have said, doctors, nurses and other health professionals will rightly respond flexibly and compassionately. In the meantime the public absolutely must play now their part by staying at home to stop the spread of this virus and save lives.”