Covid-19 Delta outbreak: NZ and its hospitals – overwhelmed or adequately staffed?

A Wellington doctor has rejected the Health Minister’s comments that there has been an increase in the number of intensive care unit beds – and has challenged him to find “just one” clinician that could support the claim.

Capital and Coast District Health Board intensive care specialist Dr Paul Young spoke out after Health Minister Andrew Little told RNZ that since the pandemic began about 100 more ICU beds had been added nationally.

“Dear @AndrewLittleMP,” he wrote on Twitter.

“I am afraid that your assertion that the number of staffed ICU beds has increased from 234 to 340 in the past 15 months is false.

“I challenge you to visit any ICU in the country and find one clinician (just one) who can show their newly staffed beds.”

Little said the Government had begun training more ICU-qualified nurses, which had reached 1400, since the beginning of 2020.

ICU capacity nationwide currently hovered around 65 to 70 per cent, while total hospital utilisation sat around 80 to 85 per cent.

“So there is some spare capacity.”

He said in the coming months people with Covid-19 could be assured that they would be cared for.

“We can surge up to 550 ICU or HDU level care beds.

“That will put planned care at risk, so people will lose planned care operations and stuff.”

There was pressure on hospitals and headway was being made to bring in more nurses to deal with Covid-19 patients in intensive care units.

“That’s why last year we started the programme of providing that additional training for more nurses, now nearly 1400, to work in an ICU environment. Even if they’re not a fully qualified ICU nurse, they can work in an ICU environment.”

Little said that plan had worked in the UK.

The Ministry would work with DHBs to help clear the backlog.

There was also surge capacity to fill crucial nursing gaps on short notice.

“We know there is a shortage at the moment, but like other healthcare professionals they are facing vulnerable people and vulnerable populations.

But Dr Young said they “desperately need a national directive and funding to staff our current ICU capacity.

“It is not about preparing for a surge [although that is still important].

“Instead, it is about preparing for a new disease which in the UK at a relatively steady state, and with a high rate of immunity, is using the equivalent of 25 per cent of our normal ICU capacity every day … adjusting for the population size.”

He said a staffed ICU bed was one where “specialist ICU-trained nursing staff are available to provide 24/7 care to a patient requiring ventilation with a staff: patient ratio of 1:1, & where at least one specialist is exclusively rostered to the ICU at all times.

“If you are receiving advice that we have 340 staffed ICU beds, you are receiving bad advice,” he wrote.

When asked about the percentage of patients in hospital that are vaccinated, Young replied, “vaccination is by far the most important thing you can do to protect yourself”.

“Almost every patient admitted to hospital in this outbreak was unvaccinated.”

When approached for a response, Little told the Herald that the figures he spoke of are reported by DHBs and “it is unlikely individual ICU specialists from individual DHBs are aware of the capacity of the system as a whole”.

“In August last year DHBs were asked to confirm what additional beds they could convert to ICU/HDU care at short notice. DHBs collectively advised they could provide up to between 320 and 340 ICU/HDU beds altogether. This would be on the basis of there being additional trained staff and access to ventilators.

“DHBs were also asked what additional capacity they could create for ICU/HDU care, even if it meant compromising planned care scheduled. On this basis DHBs advised they could increased capacity to 550.

“In order to provide this, the Ministry of Health provided additional funding to DHBs for training to allow other nurses to work in an ICU/HDU environment. Funding was also provided to create more negative pressure spaces and for more ventilators.”

Dr Richard Stubbs, general surgeon and Chairman of Medicus, said an overwhelmed healthcare system meant more than just “exhausted doctors and nurses and a lack of ICU beds.”

“The UK’s healthcare system has provided a clear example of an overwhelmed healthcare system and its impacts.

“Figures released by the College of Surgeons England show that wait lists for elective procedures have increased 10-fold from before the Covid-19 outbreak until now.

“More than five million people in the UK are currently waiting on elective procedures. This is a vast amount of people and will mean an entire generation will live debilitated or, in many cases, die early due to diseases not being caught early and treated.”

When New Zealand considered ‘opening up’ the Government needed to ensure the country was prepared to deal with Covid-19 patients at the exclusion of care for patients with exiting and other illnesses.

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