Michael Pascoe: The mystery of 2000 missing ICU beds

NSW’s intensive care unit claims may be tested in the weeks to come, writes Michael Pascoe.

NSW’s intensive care unit claims may be tested in the weeks to come, writes Michael Pascoe.

As the number of COVID victims requiring admission to intensive care units steadily climbs, a couple thousand ICU beds have gone missing – or Gladys Berejiklian has not been accurate in claiming NSW had “quadrupled” its ICU capacity since the pandemic started.

According to federal Health Department figures, NSW had ICU capacity of 846 last week, up from 785 at the start of the year and 740 on June 24 just before the current outbreak started.

But according to the Australian and New Zealand Intensive Care Society, NSW had 874 ICU beds back in 2018, a figure roughly in proportion with a survey of national ICU capacity in March last year.

And to further complicate matters, NSW Health itself claimed 592 commissioned adult ICU beds on July 23.

Yes, it is confusing, but whatever number you chose, it doesn’t look like anything has been “quadrupled” while the number of NSW COVID patients in ICU rose by another 10 on Thursday to 160.

One week before, NSW had 115 COVID patients in ICU taking up 14 per cent of its ICU capacity.

gladys berejiklian august 4

New South Wales Premier Gladys Berejiklian and Health Minister Brad Hazzard have talked up quadrupling ICU capacity.

The New Daily asked NSW Health on Wednesday to clarify the mystery of the missing capacity and the conflicting numbers. More than 26 hours later, a NSW Health spokesperson provided a non-answer.

“NSW Health has the largest and most skilled health workforce in the country and over the past decade, it has undertaken the largest health capital works rebuild in Australia’s history,” the spokesperson began and went nowhere more meaningful after that.

“Our hospitals and staff are among the best placed in the world … engaged in forward planning with clinicians to ensure our hospitals have capacity to care for COVID-19 patients who need to be hospitalised … currently sufficient ICU capacity in NSW public hospitals … vaccination on a national scale is essential … continually monitoring hospital capacity … strategies have already been implemented … local health districts have well-developed workforce surge and demand management plans…”

All that’s missing is a “gold standard”, a “please know” and any attempt to provide a single figure to support the politicians’ claims of quadrupling.

Anyone finding a few thousand ICU beds with the requisite staff ready to go, please notify Mr B. Hazzard or Ms G. Berejiklian, Macquarie Street, Sydney.

The Health Minister and Premier like to talk about the extra ventilators that have been purchased, but ventilators are useless without the staff and other facilities necessary to make them work.

The survey of Australia’s 191 ICUs at the start of the pandemic, published in the Medical Journal of Australia, found “maximal surge” could increase the number of intensive care beds by 191 per cent. (Close to the Hazzard/Berejiklian “quadrupling”.)

But that would require a 245 per cent increase in senior doctors over the baseline and a 269 per cent increase in registered ICU nurses.

Those extra trained people do not exist.

Contrary to the NSW Health Minister’s assertion, theatre nurses made surplus to requirements by cancelling surgery can’t be rapidly turned into ICU specialists.

And the MJA survey was for a “surge”. Nurses already stretched with current workloads can only physically “surge” for a limited period.

There’s a limit to the number of 12 and 14 hours that can be worked, let alone when the infection rate of healthcare workers dealing with COVID patients is high.

Given the lack of a meaningful answer from NSW Health, studying the department’s pandemic response plan (the one that counted 592 commissioned adult ICU beds in July) provides a scenario of critically ill patients being shunted into other wards and hospital rooms as their needs and prospects are triaged.

COVID hospitalisations are approaching the 1000 mark in NSW, with 16.7 per cent of Thursday morning’s count in ICU and the promise of worse to come this month and next.

On the current trend, we might not need to find all the missing ICU capacity, but we will want a fair whack of it.

In the meantime, the mystery of what our capacity actually might be adds to the undermining of confidence in how straight the NSW government has been with its citizens. It doesn’t help.

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