Maresa Fagan: Lack of ICU beds highlights cracks in our health system

As Ireland braces itself for a surge in infections and patients in need of critical care, the cracks are beginning to show this week in a public health system that for too long was short on critical care beds and staff.

In a matter of weeks our health service has been utterly transformed. Bed capacity doubled, community hubs set up, private hospitals taken over temporarily.

Nobody could have forecast or even planned the scale of change that has occurred in such a short period of time.

The extraordinary challenges presented by the Covid-19 pandemic required extraordinary measures and decision makers and healthcare staff were not found wanting in rising to that challenge.

The majority of people too are playing their part to ‘flatten the curve’. By staying at home and complying with the current restrictions they are keeping the virus at bay and ultimately preventing hospitals and staff from becoming overwhelmed by a possible surge in critically ill patients.

This week, however, the cracks in our public health system began to show, as the lack of intensive care beds became glaringly evident at one Dublin hospital.

On Wednesday Dr Cormac O’Loughlin, an intensive care specialist at the Mater hospital, warned that all of its 18 ICU beds were full, mainly with Covid-19 patients.

The hospital, he said, was moving some patients to its high dependency unit but staffing issues remained. For every patient in an ICU bed there is the need for a dedicated nurse.

“That would be threatened, that could be diluted if we stretch beyond the numbers we’re comfortable with, so that’s a bit of an unknown yet, but we have plans - all we can do is our best,” Dr O’Loughlin said.

While Dublin is bearing the brunt of Covid-19 with more than 3,000 cases confirmed, the situation could be replicated in other hospitals around the country if the anticipated surge comes.

Patients with non-Covid illnesses will also require intensive care.

Before the pandemic there were less than 180 ICU beds across our health service but that number has more than doubled as hospitals put contingency plans in place to prepare for the worst.

Since the end of February close to 200 Covid-19 patients were admitted to intensive care units across the country. They account for 14% of all Covid-19 patients hospitalised to date.

The fear, however, is that this number could spike rapidly in the days and weeks ahead and overwhelm our hospitals, as witnessed in Italy and elsewhere.

The shortage of critical care beds and staff in our hospitals, however, is not new.

As the Covid-19 crisis was unfolding we learned that Ireland compared poorly to other European countries.

President of the Intensive Care Society, Dr Catherine Motherway, did not pull any punches when she confirmed our hospitals’ limited ICU capacity to deal with a public health emergency like Covid-19.

“We are roughly at about half the European norm and about half the beds that Italy would have. This has been a well-documented situation,” the intensive care consultant at the University Hospital Limerick told RTÉ Prime Time.

The stark reality comes after several reports in recent years highlighted the need for more critical care beds.

One such audit in 2018 found that all ICU units were operating at 13% above recommended bed occupancy levels (75%) and often experienced delayed discharges and delayed admissions.

And by its own admission, the Department of Health has identified the need for an additional 190 critical care beds by 2031, following a bed capacity review two years ago. That’s on top of another 7,000 hospital beds needed in the next 10 years.

These reports were published before Covid-19.

We are now in a different place, where hospital surge plans will be sorely tested in the days and weeks ahead.

Patients being admitted to intensive care with Covid-19 can require up to two weeks of care to overcome the infection.

With every passing day, Covid-19 is putting pressure on our hospitals and there is no room for complacency, Dr Motherway said on Wednesday, as she appealed to everyone to play their part and stay at home.

“The numbers are steady and creeping but Dublin still remains under pressure. There is capacity in the system. In at least four of the hospitals that capacity is surge capacity,” the intensive care specialist said.

“We are under pressure. We are very grateful to the public for what they have done but we need them to continue to do that so that we have the time and the space to treat our patients,” Dr Motherway added.

Her message was clear. Our hospitals are holding up for the moment but there is only so much stretch in the system.

We must deal with the immediate pressures on our hospitals and health services to get through this public health crisis.

Once this pandemic is behind us through, change must happen. Things can never be the same after Covid-19.

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