Intensive care services for the sickest patients are to be moved out of Leicester General Hospital because of ongoing concerns about staff shortages and patient safety.
University Hospitals of Leicester NHS Trust has confirmed it has been given the go-ahead to relocate level 3 beds – and associated clinical services – as part of a plan to consolidate over-stretched intensive care provision.
“Staff have gone above and beyond what could reasonably be expected of them to make sure the unit remains open”
This will involve moving level 3 provision to an 11-bed extension at Glenfield Hospital, which is on the outskirts of Leicester, and opening a six-bed intensive care unit (ICU) annex at the Leicester Royal Infirmary. Leicester General will continue to care for level 2 patients.
Controversially, the move, which also includes shifting beds for emergency surgery, kidney transplant and liver disease patients, will take place without full public consultation to avoid further delay.
A report from the trust to Leicester, Leicestershire and Rutland Joint Health Scrutiny Committee shows the unit at Leicester has faced “significant operational difficulties” for several years.
Senior nursing and medical staff raised concerns about the facility’s ability to provide safe, high-quality care in 2014 due to staffing issues compounded by a national shortage of experienced critical care nurses and doctors.
However, plans to merge level 3 intensive care had to be put on hold due to lack of capital funding, said the report.
“Following extensive legal advice on their position around consulting, they have decided that we should press ahead”
It shows the unit at Leicester General has managed to limp on, but only because “staff have gone above and beyond what could reasonably be expected of them to make sure the unit remains open”.
The services “remains fundamentally unstable” and “the daily risk is that any additional loss of key clinical staff would further destabilise the unit”, said the report.
Further losses of key staff would mean the trust would cease to provide a surgical service, resulting in about 1,800 patients needing to travel to acute trusts outside of Leicestershire for surgery.
“Aside from the obvious inconvenience to patients and their families this would mean a loss of £15m to the trust’s income,” said the report.
The government has allocated more than £30m of Sustainability and Transformation capital funding to the ICU consolidation scheme.
The trust’s latest board papers confirm the organisation was told by local clinical commissioning groups that it can press ahead “without consultation”.
“Following extensive legal advice on their position around consulting, they have decided that we should press ahead with our moves/development without consultation so that we do not lose the capital funding or delay the moves any further,” said a report from trust chief executive John Adler.
He highlighted that this position “was not reached easily”, with the decision made in consultation with local councils.
The trust would be staging a series of public engagement sessions to talk about wider plans for reconfiguring health services “but also to answer questions about our plans to develop intensive care facilities”, he said. A number of staff events are also planned.
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A trust spokeswoman stressed the organisation was keen to hold on to all staff and there would be no redundancies, although it had yet to look at how staff might be redeployed.
“If they choose not to come with us and follow the service to where it needs to be, then we’ll have to have conversations with them about redeployment or it might be that some of them stay to manage the high dependency unit beds at the general,” she said.
Figures provided by the trust show the current ICU nursing establishment at Leicester General is 41.54 band 5, 9.73 band 6 and 2.81 band 7 nurses.
The number of nursing vacancies as at the end of October for all three adult ICUs and across all qualified nurse bands was 24.34.
She said the trust was proposing to start building an extension at Glenfield Hospital in the new year and it was likely to be finished towards the end of 2019. Some building work has already taken place at Leicester Royal, which means six extra ICU beds can be accommodated.
Ultimately, she explained the aim was to create two “super ICUs” at Leicester Royal Infirmary and Glenfield, as part of Leicestershire’s £367m Better Care Together plan.