Critical Bed campaign update

Dear Councillors

Update on Critical Beds Campaign visit to Downing Street on 12th July

“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.”

The quote above is from the CQC of 2nd July 2015 about King George. A longer report from the CQC about Queens is below.

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.

Incident reporting was variable and staff were unclear about which issues to report. Learning from reported incidents was not always apparent and staff told us there was little change after raising issues. Patient records, including consent and mental capacity assessments, were completed in most cases but we found some gaps in care plans and inconsistency in prescribing resulting in controlled drugs being administered without a valid legal prescription.

There was limited space. This resulted in small bed areas and no space for dedicated hand wash facilities or waste bins for each patient space. There was limited available storage for equipment. In most cases, equipment was cleaned in line with the infection control policy but some areas of the unit were not cleaned to the highest standard.

There was little multidisciplinary team working evident on GICU. Physiotherapists attended handovers but access to other professionals was on a referral basis. On NITU, structured MDT meetings were held for long term patients. Pastoral support was available across critical care 24 hours a day.

The leadership team had a strong vision for future expansion of critical care services but this had not been shared with the ward staff. Staff had a mixed understanding of the vision for critical care and the reconfiguration had left some uncertainty about the future expansion plans.

Care and treatment was delivered by trained and experienced nursing staff who worked in dedicated teams. There was suitable medical cover provided by specialist consultants and junior doctors.

Policies and protocols we observed were based on national guidance and international guidelines. The critical care units completed local audits and evidence based work when no national guidance was available. The GICU participated in a national database for adult critical care. Patient outcomes and mortality were within expected ranges when compared to similar services. The outreach team supported ward based staff in the early identification of patients at risk of deteriorating and who may require an HDU or ICU bed. CCOT also provided an outpatient clinic to support previous critical care patients in the months after their admission and to ensure they continue to progress.”

The quote above is from the CQC report of 2nd July 2015 about Queens.

The June 2018 CQC report about BHRUT does not seem to have investigated critical care and instead refers to the 2015 report.

A June health service journal report headlined “Bed shortages causing dangerous surgery delays” highlights how important critical care beds are (1) The health service journal mentions a NHS June 2018 review into Cranial Neurosurgery (2) In particular the health service journal report claims “Bed shortages cause dangerous delays in cranial neurosurgery”

The BHRUT website says Queens provides cranial neurosurgery:

“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.” (3) These neurosurgical beds appear part of 44 of the critical care beds at Queens

As these neurosurgical beds have a large catchment area for North East London, Essex and Kent. It seems reasonable to seek funding for more of these beds to order to cope with the growing population in this area.

I sent you an Freedom of request earlier shows critical care beds at both Queens and King George frequently full up February 2018.

I have copied BHRUT for any comment that may wish to make.

I attended the Redbridge Health and Well Being Board yesterday per the recording here to raise the issue around 7 minutes in:

Andy Walker - Andy Walker was live.

Andy Walker - Andy Walker was live.

Cllr Ryan is interested to know if patients have been put at risk of harm as a consequence of critical care beds being full up (I paraphrase). The CQC report above suggests that operations for seriously ill patients will have been cancelled due to critical care beds being full up,

Dr Mehta said he would look “into the matter” at around 8 minutes into the recording.

As well as the neurosurgical issue, the prospects of surviving emergency Laparotomies appear to improve if a critical care bed is available (4,5,6) Other conditions will also improve for seriously ill patients if a critical care bed is available.

At point 7 below I have drafted a letter for both the Ilford Recorder and Romford Recorder for next week. It would be great to have Labour support for these letters (7) I need to know if we have a Labour Cllr on board by 9am on 3rd July. I hope either BHRUT or Dr Metha could clarify points about how many and where critical care beds where increased since the 2015 CQC report and if BHRUT can say if 100% critical care bed occupancy has led to operations being cancelled.

Point 8 below is photo around of 20 years ago when I supported a Trades Council campaign against the Oaks Park school being a PFI deal. Back then we did not have the support of the major parties and the campaign was lost. I learned that to win a campaign it is vital to get as much support as possible. If Labour come on board the campaign for more critical care beds, we can ask faith groups to come on board and maximise the prospects of more critical care beds at King George and Queens for the 2018/2019 winter.

It seems best to run the critical care bed campaign off the save King George hospital blog in future if Labour come on board.

Regards

Andy

1) - https://www.hsj.co.uk/quality-and-performance/bed-shortages-causing-dangerous-surgery-delays-report-finds/7022741.article?mkt_tok=eyJpIjoiWVdSa09Ea3hOMk00TVRrNCIsInQiOiJPcmE5VjJPVnRRV3pldlF3bkxWMFlLaWpHUDFTanpvUFJUd1I2ODBYVFRcL1ZPZjJYc3AzemVBWlVXMkl2eWNcL1VYa3FVZFV4S24raEVqNU5RamtSV01WVU8xTHhTSDdwN1dJeitzd0dQd1M1NXU4ZnVtNWxueUoycndDYlo4ZlJuIn0%3D

2) - http://gettingitrightfirsttime.co.uk/wp-content/uploads/2018/05/GIRFT-National-report-on-Cranial-Neurosurgery.pdf

3) https://www.bhrhospitals.nhs.uk/neurointensive-care

4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4311539/

5 BHRUT presentation on critical care at https://redbridgetradeunionparty.files.wordpress.com/2018/05/critical-care-bedspdf.pdf

6. http://www.nela.org.uk/Third-Patient-Audit-Report#pt

Statistics from the 2017 audit at point 6 shows King George with 101 and Queens with 186 emergency laparotomies. These emergency operations seem bound to increase with our growing population. The red warnings for both King George and Queens suggest critical care bed issues for both hospitals when critical care beds may be at 100% bed occupancy on some days.

7. Draft Letter to Ilford Recorder (this is to go to BHRUT prior to publication in case of any errors) a similar letter for the Romford Recorder will be drafted

Dear Sir or Madam

In 2015 the CQC reported:

“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.”

However, the King George Critical Care unit remains at only 8 beds. These need to be increased as in February of this year the unit was full up 12 times. Critical Care beds at Queens have also been full up, sometimes on the same days as King George.

Some of these life saving beds cover a catchment area of North East London, Essex and parts of Kent. We go to 10 Downing Street on at midday on 12th July to call for more funding to increase critical care beds for both King George and Queens. Your support on the day in person or on social media will be welcome. More at savekinggeorgehospital.blogspot.com/ ENDs list to Elected Representatives attending and other supporters. ENDs

8) Old Trades Council pic from 1998 attached.