Acutely ill children waiting nine hours for beds in intensive care

Some paediatric units now at 115% capacity, warns doctors’ body

Seriously ill children are waiting up to nine hours for an intensive care bed to become available, while others are being transported up to 120 miles from their homes to receive the medical treatment they urgently need, senior paediatricians have revealed.

In the last two weeks, at least 17 children with acute illnesses requiring intensive care have had to be transported out of their regions because of a lack of beds. Some paediatric intensive care units, treating the most seriously ill children, are working at 115% of their capacity, such is the level of demand and lack of resources, according to the Paediatric Intensive Care Society. As of Friday night, there were just four beds available in England and one in Belfast.

The revelations illustrate the stress being faced by the NHS this winter. New figures provided by the Labour party additionally show that, in October, only 67.3% of ambulances for the most seriously ill adults and children, who are not breathing or do not have a pulse, arrived on the scene within eight minutes of being called, against a target of 75%.

Dr Peter-Marc Fortune, a consultant paediatric intensive care specialist and president of the Paediatric Intensive Care Society, said the network of intensive care units had been officially designated “critcon 2” at a national level, meaning that the system was running at “full stretch”. Last week the Observer revealed that units in London and Leicester were at full capacity.

Fortune said the situation was now “hottest” in the north of England and added that he feared that the status of the availability of paediatric intensive care beds could in the coming days be designated as “critcon 3”, defined as an unprecedented situation under which three of the four regions declare themselves as working at maximum capacity.

He said: “I have heard back from about a third of the units in the country. None of them were running at less than capacity. And there were reports of anything up to 115% of what would be the commissioned full level.

“There is no suggestion anyone has come to any harm because of this. However, we are concerned that the system is stretched to capacity and that any further stress on the system may risk a reduction in safety standards.

Dr Peter-Marc Fortune, president of the Paediatric Intensive Care Society.
Dr Peter-Marc Fortune, president of the Paediatric Intensive Care Society Photograph: YouTube

“We find ourself in this position because a number of beds are commissioned across the country and during the year this capacity copes.

“Anecdotally, bed occupancy on most units runs above 85% for much of the year. And 85% is widely regarded as the maximum figure of activity in order to deliver both efficient and safe care. When we come to the busiest period, which is traditionally the second and third weeks of December, the system is obviously going to be stressed. It is being pushed to its absolute limits.”

Fortune said he was aware in the last two weeks of a child having to be transported 120 miles to an intensive care bed, and a second case in which an acutely ill child had to wait nine hours before a free bed could be identified.

He said: “Fortunately with that particular child it was possible to deliver all the therapies via our mobile team. There are therapies that require a child to be physically in an intensive care unit. If there were an occasion when such therapies were required, with no beds immediately available, we could be forced into a triage situation where other children may have to wait or be moved between beds.”

Details of the current situation have emerged as a report from the Paediatric Intensive Care Audit Network (Picanet) lays bare the strains on the system. In 2015, only about a third (29%) of the country’s paediatric intensive care units (PICUs) met the nursing establishment levels currently recommended by the Paediatric Intensive Care Society.

One in five referrals for admission to a PICU are refused, with nearly two thirds of these refusals due to no staffed bed being available. The report notes: “While most children who require a PICU bed will eventually be admitted, the process of approaching many PICUs to find a bed is time-consuming and stressful for parents and carers and hospital staff.”

NHS England said data for a week ago showed units running at 85% of capacity.


Daniel Boffey

The GuardianTramp

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