Surge Capacity

Secondary & Community care, mental health & learning disability

(Trusts)

Ensuring readiness• PHA/HSCB/BSO Surge Assessment group• Reviewed Trust Plans• Regional workshop mid-June• Trust self-assessment checklists• Report on readiness 30th June• Plans resubmitted end July• Face to face meetings with Trusts• Resubmitted checklists – significant progress• Surge assessment report to next programme Board

Regional Business Cases• Virology equipment & staff• Critical care expansion

– Adult – Paediatric

• Neonatal intensive care expansion• Nursing & AHP training• Appointment of staff to nurse banks• Community respiratory equipment• Beds & mattresses• Other community equipment

Critical Care CapacityEstimated demand for critical

care admission in NI

Scenarios

(i) 30% Clinical Attack Rate, 2% hospitalisation rate & 25% critical care admission (all age groups)

(ii) 50% CAR, 2% hospitalisation rate & 25% cc admission rate (children)

(iii) 50% CAR, 1% hospitalisation rate & 25% admission rate (children)

Critical Care CapacityEstimated demand for critical care admission in NI

0-4 years 5-9 years 10-14 years Adult>14 years

Cumulative Over 15 week surge period

30% CAR2% hosp rate

173 173 186 2109

50% CAR2% hosp rate

289 288 307 n/a

50% CAR1% hosp rate

144 144 153 n/a

In week 6 (peak)

30% CAR2% hosp rate

37 37 40 456**

50% CAR2% hosp rate

62 62 66 n/a

50% CAR1% hosp rate

31 31 33 n/a

•*This excludes neonatal intensive care demand•**Maximum capacity in adult units is 158 beds

Additional paediatric critical care beds needed in peak week

(7 day average length of stay & 98% occupancy)

H1N1 Attack rates & hospital admission rates

30% CAR2% admission

50% CAR2% admission

50% CAR1% admission

0-4 years 38 63 32

5-9 years 38 63 32

10-14 years 41 66 34

Total 117 192 98

Critical care expansion plans• Adult ICU beds - currently 57 + 13 CSICU During peak surge will rise to 158 (increase of 126%) Requires 47 extra ventilators and 215 pumps @ £1.4m

• Paediatric ICU beds – currently 8 in RBHSC During peak surge will rise to 29 in BHSCT plus 20 in

DGHs (increase of 510%) Requires 38 extra ventilators and 220 pumps @ £1.6m

• Neonatal (level 1) beds – currently 21 During peak surge will rise to 63 (increase of 200%) Requires 36 extra ventilators & 179 pumps @ £2.3m

Challenges• Critical Care capacity versus demand• Application of triage (SOFA) and reverse triage• As yet no agreed triage process for children• Uncertainty on scale of cases of premature

labour & hence neonatal demand• Lead time for equipment procurement• Phasing of increased critical care capacity (staff

ratios & locations)• Firm plans for staff redeployment (no double-

counting)

Challenges• Ensuring PPE availability and match to fit-testing• Time for staff to have training for redeployment• Core regional services – equity of access• Timing of turndown of elective work• Business case processes

– Variation in Trust proposals (quantity and costs) to deliver similar services

– Capacity of Trusts to develop cases to DHSSPS standards

• Public (& professional) expectation • Timely & transparent communication to the public &

professionals of changes in service access