Explained: Are Wales' critical care units really full?

It is only October - winter has not yet started - and already the Welsh Government is telling us that critical care is full.

In Monday's government briefing where the First Minister announced a two-week fire-break lockdown for Wales, he told the press conference, "If we do not act now, it will continue to accelerate and there is a very real risk our NHS will be overwhelmed."The number of people being taken to hospital with coronavirus symptoms is growing every day."Our critical care units are already full."

It doesn't take a critical care doctor to tell you that that is not a good thing, but what does it mean in reality? Is it really 'full'?

A glance at some of the latest statistics published by the Welsh Government suggests that things are not "full". 

The graph below shows that there are still Invasive ventilated beds that are vacant.

As of October 13, the statistics say, "25 invasive ventilated beds were occupied with COVID-19 related patients; this compares to 28 beds in the previous week and to 164 at the peak in April."

Credit: Welsh Government/NHS Wales Informatics Service

Since 2013, intensive care capacity hasn't climbed above 81.4%.

  • So how can critical care be "full" and there still be beds available for those who get really sick?Speak to doctors working in intensive care (or critical care, ITU, ICU - they're all used interchangeably) and they will point the finger at staffing. 

Critical care capacity is only useful if you have people to staff it.

When you exhaust your ability to staff beds in critical care, say doctors, you reach your capacity regardless of how many beds might be vacant.

This, it's suggested, is why Welsh Government is saying critical care is full.

  • So what happens if more people come in and need those critical care beds?

That's when health boards increasingly start to make tough choices about services. In the first wave, staff who wouldn't normally work in critical care were drafted in to help. But while they were helping in critical care, it meant they weren't staffing operating theatres and alike. That means operations had to be cancelled.

In the first wave, thousands of operations were cancelled and the NHS in Wales now has a huge backlog.At the moment the NHS is trying to keep as many services going as possible, alongside dealing with the second wave, but there will likely come a point where more and more things have to be stopped in order to free up staff to help with covid-related patients.

  • "If I have more intensive care patients, I need more nurses"

In an interview with ITV Wales, Dr Ami Jones, an intensive care consultant at Neville Hall Hospital in Abergavenny said they currently do not have the same level of resources they did in the first wave of coronavirus - and if that were to happen again, it would result in the cancellation of other services and operations to cope with demand in critical care units.

"My ITU is quite small - we normally have 8 beds. We've gone to a double sized unit - those beds aren't full at the moment, but we are coping with Covid and non-Covid patients which in the first wave we weren't having to do.

"We're pretty busy - we're not at breaking point yet but we don't have the resources we had in the first wave.

"If I have more intensive care patients, I need more nurses and last time we ended up cancelling operations and pulling theatre nurses in. Obviously, nobody wants that to happen because that's cancer operations cancelled and other vital services cancelled. So, we are prepared, but it will come at a cost to the rest of the NHS."

  • Why not use the field hospitals?

Aside from the above point about staffing, field hospitals are not as well equipped as fully-fledged hospitals. They are not intensive care units.Wales may have many thousands more beds available to deal with the pressures of the second wave of Covid-19 but, in the words of those working in intensive care: "An ITU bed without a nurse, is just a bed."