The situation in UK intensive care units (ICUs) is grave. Across the UK, units are under immense pressure and are as busy or busier than they were in the first wave. All plans enacted over the summer to provide support for critical care services going into winter pressures have been stretched and then stretched again. Stories from exhausted staff and overcrowded wards, particularly in London, show how close to breaking we are. Both the prime minister and the CEO of the NHS, Simon Stevens, have raised the spectre of critical care treatment becoming limited if demand exceeds supply.
We went into this pandemic with fewer staffed, funded critical care beds compared with other developed nations. Germany has 29 ICU beds per 100,000 population, the US around 25, the UK 6.6. The Faculty of Intensive Care Medicine, the professional body responsible for all doctors working in intensive care in the UK, had highlighted this and possible solutions in its critical condition and critical futures reports. More training in intensive care skills for healthcare staff and better ways of identifying the workload that an intensive care nurse can safely do were issues we highlighted. There has not been the wholesale development of services that was needed and which would have helped us cope better in this pandemic; intensive care was just another competing healthcare interest in an NHS with a limited budget.
A troubling narrative now appears to have crept into some reporting of intensive care bed shortages – blame the public. Social and conventional media are awash with comments from exhausted and understandably frustrated fellow healthcare workers who suggest individuals may have “blood on their hands” or need to “fuck off”. We are trying to cope with a significantly more infectious form of coronavirus, a lockdown with more exemptions that are open to interpretation than previous lockdowns and an apparently unstoppable rise in the number of cases presenting to hospitals. It is people living in areas of the country with the most social deprivation, poor, cramped housing and multigenerational living who experience the highest risk of catching Sars-CoV-2, require hospital admission, become critically ill and, sadly, die.
In desperation, it is tempting to seek to apportion blame when all apparent previous exhortations have failed, but this is too easy and too simplistic. In doing so, we run the risk of feeding the trolls who call us liars when we show the harsh realities of intensive care treatment in a pandemic and losing the goodwill of those trying their best to comply.
Doctors and other healthcare workers are trusted professionals. That trust comes in part because of the contract we make with you, the public, in acting to provide care and treatment where we can, without judgment. We do that in relation to treatment for road traffic collisions irrespective of who is “at fault”, vascular diseases where the individual may have damaged blood vessels due to smoking and forms of cancer where lifestyle factors are known to play a part as much as genetics. We do it because it’s the right thing to do because health is so valuable. We do not know who will need our help until they do and in each case we treat and care without judgment.
We know that 10 months of restrictions on how we live our lives have been tedious and frustrating. Now, as healthcare professionals, we are asking each and every member of the public to join in this contract with us. Act without judgment and selflessly. Do what is asked of you for the sake of those you have not met and may yet need our help, as much as those close to you who have or will be treated by the NHS at some point in their lives.
Our message is simple. Please stay at home and protect lives. Follow the rules.