intensive care beds will be swamped experts warn

Hospital intensive care beds will be swamped with swine flu patients if the virus reaches epidemic levels as expected this winter, experts have warned.

Dr Bob Winter, president of the Intensive Care Society, said information from Australia and New Zealand, is that their intensive care beds are swamped as 15 per cent of swine flu patients in hospital require specialist intensive care.

Dr Winter said: "If that happened here we would be screwed.

"If Australia and New Zealand are saying they are swamped then if we will get swamped here."

There are more cases per head of population in Australia and New Zealand than in Britain as the southern hemisphere is in the middle it is winter season when flu normally thrives.

It is hoped that the first vaccinations will begin before the winter in Britain and will help to reduce the impact of the winter flu season here.

Britain has fewer beds per head of population that most countries in Europe, Dr Winter said.

There are just 3,637 intensive care beds in England, according to the latest Department of Health data and there are plans for each hospital to double their capacity as swine flu spreads.

If demand for intensive care beds outstrips capacity then doctors will be forced to choose which patients will benefit the most from the extra care.

The Intensive Care Society has now reissued its ethical dilemmas guidelines after Sir Liam Donaldson, chief medical officer, warned last week that in a worse case scenario 30 per cent of the population could be infected with H1N1 this winter and the NHS has been told to prepare for up to 65,000 deaths.

So far there have been 652 people admitted to hospital with H1N1 and 53 of them required intensive care.

The Intensive Care Society guidelines said: "ICUs have (just) managed to cope with the numbers of referrals so far – but there are serious concerns that this situation may change, and if the higher level statistics recently contained in the CMOs update are reached the situation may be even more demanding than had been anticipated in preparation for an H5N1 (more dangerous bird flu) pandemic."

With children being hit the hardest there is a major concern over the number of paediatric intensive care beds.

The document went on: "Given that there may be significant numbers of children who may have to be treated (and possibly ventilated) in District General Hospitals because of lack of paediatric intensive care beds the implications could be very serious.

"There are also concerns that staff who have to provide care for these children may be working outside of their normal area of expertise – and consequently there is a significant probability that the standards of care / outcomes may not be as good as normal expectations."

Despite the dire warnings Dr Winter, who works in Nottingham, said: "So far I have spent more time in meetings planning for swine flu than I have treating people with swine flu."

Dr Terence Stephenson, president of the Royal College of Paediatrics and Child Health, said of the 135 children under the age of five admitted to hospital with swine flu, nine have needed intensive care and the majority of children are suffering only relatively mild flu.

He said if the situation worsened more beds could be found but he added: "There is no healthcare system in the world that could cope with a pandemic hitting 30 per cent of the population. It is a difficult situation, you cannot have the beds and staff doing nothing waiting for a pandemic."

A hospital manager in London, one of the swine flu hot spots, told the Telegraph: "The obvious comparison is with winter 1999, when intensive care beds were full of elderly patients with chronic breathing problems made much worse by seasonal flu.

"There were serious knock-on effects for other patients, whose operations had to be cancelled because there were no post-operative intensive care beds for them. In some cases, such as Mavis Skeet's, the results were tragic.

"We all hope the Department of Health will pay heed to this potential problem before it becomes a very real crisis. We may need to look at different ways of managing patients who need ventilation."

Mavis Skeet, 74, died in 2000, following the last flu epidemic, after her throat cancer operation was repeatedly cancelled because there were no intensive care beds in Leeds to care for her after surgery.

A spokesman for the Department of Health said: "As part of our preparations, guidance has been issued which contains information for primary and secondary care services in the UK on managing surge capacity and the prioritisation of services and patients during an influenza widespread outbreak.

"The guidance also identifies how maintaining an essential health service will be a community effort involving: self care, support for those for whom hospital admission is not deemed appropriate, and supporting early discharge of patients from hospital."

A survey of healthcare workers has found that only around four out of 10 health believe their organisation is managing to cope with the extra flow of patients caused by swine flu.

Just 37 per cent of clinicians, including doctors, nurses and midwives, agreed or strongly agreed with the statement that their organisation was coping well.

Another 30 per cent neither agreed or disagreed while 13 per cent disagreed and five per cent strongly disagreed.

However, many doctors and nurses said the Government had provided useful advice to help them cope with the pandemic and most would not stay away from work if other staff became ill.

The survey, of almost 1,500 NHS managers, nurses and doctors was carried out by the Health Service Journal and the Nursing Times.

The UK Government has ordered up to 132 million doses of the vaccine from both GSK and Baxter.

Around 60 million doses – enough for half the population at two jabs per person – is expected to arrive before the end of the year.

GlaxoSmithKline has been criticised for profiting from the outbreak by overcharging for its vaccine. Andrew Witty, chief executive, denied profiteering and said the company had spent £1.2bn on vaccine technology in the past four years and had a very reasonable pricing policy.

The British Medical Association also insisted today that doctors were not trying to profit from the vaccination programme for swine flu.

The BMA is currently in negotiations with NHS Employers about how any extra costs can be met and at which point GPs stop doing some of their normal workload, for which they are paid according to disease area.

Dr Laurence Buckman, chairman of the BMA's GPs Committee, said: "Clearly a mass vaccination programme would be on a scale much larger than the seasonal flu jab campaign which targets only at risk groups.

"A range of possible options is being discussed and we would hope to have an agreement very soon.

"GPs are not looking to profit from any vaccination programme but would reasonably expect to have any extra costs met, such as bringing in extra staff to administer the vaccine.

The National Flu Service is expected to be launched this week with a phone line and website for people who think they have H1N1 in order to ease pressure on GPs.