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Ian Dalton's swine flu update - critical care can cope with increased capacity

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In his fifth weekly update for Nursing Times and HSJ, national director for NHS flu resilience Ian Dalton discusses increasing critical care during the second wave of swine flu

What should NHS Staff be focusing their efforts on?:

Over the last couple of months I have been working with all 10 SHA regions, following a request from the Secretary of State, to look at how they might increase their critical care capacity during a potential second wave of the pandemic should this be necessary.

On the 10th September I was delighted to be able to write to the Secretary of State to let him know that all 10 SHA’s have responded and confirmed that in their area they can double the ventilated critical care capacity during the peak weeks of a potential second wave and importantly, can sustain that increased capacity for at least 8 weeks.

A full critical care capacity strategy is available on the DH website, which sets out how the NHS will collectively achieve this increase. Some examples of the measures include:

  • creating additional Level 3 beds by upgrading Level 2 and post-operative surgical beds;
  • specialist medical and nursing staff caring for more patients than usual;
  • staff with experience of working in critical care redeployed to critical care units;
  • redeploying ventilators and other essential equipment;
  • temporary postponement of inpatient elective surgery and reduction

These are rare measures that clinicians have been involved in agreeing, and it is important for both staff and managers to understand that these will only be implemented in the unique circumstances presented by the pandemic.

I have impressed on the SoS that identifying this potential increase in capacity is a significant achievement for the NHJS and is the result of a huge amount of work by nurses, doctors and managers in every hospital, ambulance trust and PCT in the country.

To support the NHS to deliver on the strategy I am also pleased to be able to report that De Judith Hulf CBE, President of the Royal College of Anaesthetists, has agreed to chair a new Swine Flu Critical Care Clinical Group, which will offer advice on management, staffing and logistics issues to help manage the increased demand for care. This group will have representation from bot the specialist intensive care societies and a number of independent clinical experts in delivering clinical care.

The next steps:

We are also publishing a consultation on possible temporary changes to the Mental Health Act 1983. The proposed changes will further strengthen our resilience as during the peak of a pandemic they will enable SHA’s to provide continuity of security as set out by the 1983 Act.  The consultation is running until the 7th October, if you would like to respond to the proposed changes please visit the DH website.

I continue to be impressed by and grateful for the efforts of the Service to meet the demands of resilience planning during this current pandemic but as I have said in previous weeks this does not mean that planning is finished.

We cannot be complacent and I will continue to work with the NHS Flu Lead Directors and their teams, using the time between now and the start of any second attack wave to ensure we are as prepared as possible to respond. In recognition that any local spikes in the disease over the coming months may require a further local increase in capacity, I am asking all SHAs to work with local organisations to put regional plans in place, should this arise.

Progress to date:

There continues to be a downward trend in the numbers of cases of reported swine flu, as are the weekly GP consultation rates. The HPA have published their weekly figured where you can find more details about hospitalisations and deaths.

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