WORK FORCE I S SUE S
Best practice frameworks for critical care staffing
Dr. Jack Parry-Jones FRCP FFICM urges the Government to look intently at solutions to the increasing pressures on critical care services. In this article, he outlines the key areas that need to be addressed.
The COVID-19 pandemic brought additional pressures on a system that was already struggling. The ensuing cost to people has been unprecedented. Patients and their families bore the greatest burden, but many critical care staff suffered and, for those remaining, their struggles now continue. What we need to do now is to look at three key areas to ensure that: we have enough staff; we have sufficient critical care bed capacity; and we are prepared for future pandemics.
In November 2022, the UK COVID-19
Inquiry opened its third investigation, which considers the impact of the COVID-19 pandemic on healthcare in England, Wales, Scotland and Northern Ireland. Staffing levels and critical care capacity is one of 12 key areas in scope. Despite what some politicians may say, and without pre-empting the inquiry’s findings, we can with confidence say it will not find the UK went into the pandemic with too many intensive care staff, staffing too many critical care beds. The necessary rapid expansion of critical care units in 2020, which overstretched critical care staff and resources, would not have been able to provide adequate patient care to all who needed it without considerable support. Additional staffing was essential; in particular coming from colleagues in anaesthesia, respiratory medicine and acute general medicine, as well as from less obvious quarters including theatre staff, recovery staff and medical students. Even before the pandemic, my colleagues and I knew critical care services were under resourced, with inadequately staffed critical
care bed provision to meet the UK population demand in normal times, let alone in response to a respiratory viral pandemic. What is also increasingly apparent,
however, is that insufficiently staffed critical care bed capacity in the 21st century has a big knock-on effect across other areas of secondary healthcare provision. It is this knock-on effect that is so badly hampering the broader NHS recovery. This is impacting
In comparison to most other European countries our staffed critical care capacity is significantly lower; it is a third of Germany’s, and considerably lower than that of France, Italy, Spain and the European average.
JANUARY 2023
negatively on patients, health outcomes and staff; in particular those staff working in A&E units, anaesthesia, elective and emergency surgical services. The Faculty of Intensive Care Medicine, among others, has repeatedly made clear the need to expand staffed critical care capacity.1 For the UK critical care community, the COVID-19 pandemic provided many surprises, but the lack of staffed critical care capacity was not one of them. In comparison to most other European countries our staffed critical care capacity is significantly lower; it is a third of Germany’s, and considerably lower than that of France, Italy, Spain and the European average. Moreover, there is substantial UK regional variation in provision, thus contributing to the need to move critically ill patients between regions at times of excess demand.
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