NHS England suspends one-to-one nursing for critically ill Covid patients

Nurses will be allowed to look after two critically ill Covid-19 patients at the same time after NHS bosses relaxed the rule requiring one-to-one treatment in intensive care as hospitals come under intense strain.

NHS England has decided to temporarily suspend the 1:1 rule as the number of people who are in hospital very sick with Covid has soared to 11,514, of whom 986 are on a ventilator.

The move comes amid concern that intensive care units, which went into the pandemic already short of nurses, are being hit by staff being off sick or isolating as a result of Covid.

It follows a warning last week by Prof Chris Whitty, England’s chief medical officer, that the Covid resurgence could overwhelm the NHS.

Dr Alison Pittard, the dean of the Faculty of Intensive Care, which represents doctors in ICUs, welcomed the shift to a more “flexible” nurse/patient staffing ratio in critical care. But she said it must be used only for as long as the second wave is putting units under serious pressure.

“Covid has placed the NHS, and critical care in particular, in an unenviable position and we must admit everyone for whom the benefits of critical care outweigh the burdens. This means relaxing the normal staffing ratios to meet this demand in such a way that delivers safe care, but also takes account of the impact this may have on staff health and wellbeing.

“The 1:2 ratio is a maximum ratio, to be used only to support Covid activity, [and] not for planned care, and is not sustainable in the long term. This protects staff and patients”, she said.

NHS England has agreed the relaxation with the British Association of Critical Care Nurses, which represents specialist nurses who work in high-dependency units and ICUs. They are due to confirm the arrangement in a formal announcement soon.

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Whitty used an interview last week with the British Medical Journal to warn that the combination of Covid and usual cold season surge in illnesses will bring “an extremely difficult winter for the NHS – one that I suspect, unfortunately, will be unlike any we’ve seen in recent memory”.

One of the ways Covid can lead to deaths is through “an over-running of the emergency services such that all emergency care stops. We fortunately avoided that in the first wave, but it’s not a given if we don’t take strong action.”

The NHS-wide lack of critical care nurses was a key factor in the 1:2 decision, Pittard added.

“The [revised] guidance is needed because we do not have enough critical care staff to support the increase in beds required to care for all the patients with Covid and those with other conditions needing admission.

“There is [also ongoing Covid-related] sickness that makes the current situation worse, but the main issue is the longstanding failure to expand the workforce, and that is doctors, nurses and allied health professionals,” she added.

The new 1:2 ratio is much better than NHS England’s decision in the spring to allow critical care nurses to look after as many as six Covid patients if patient numbers required that. However, it is thought that despite that change then, no nurse cared for more than four patients in the first peak.

Susan Masters, the Royal College of Nursing’s director of nursing, policy and public affairs, said: “Reducing the ratio of nurses to patients must be a temporary measure and only when it is absolutely necessary. We must ensure patient safety at the same time as protecting the wellbeing of the nurses who care for them.

“This change means increasing the workload of intensive care nurses and there must be consideration of the physical and emotional toll this will take.”

NHS England declined to comment directly on the change in guidance. A spokesperson said only that “the NHS has 13,000 more full-time equivalent nurses than we did last year and record numbers have signed up to start nursing degrees this autumn”.

“However, with Covid-19 infections rising again both here and across Europe, the medical royal colleges and professional associations have made it clear that just as they did during the first Covid wave, doctors, nurses and other health professionals will of course treat everyone who needs critical care.”