NHS chief says they couldn't attract ICU specialists to Ayr

NHS Ayrshire and Arran took the decision to move all the beds in the intensive care unit (ICU) at University Hospital Ayr to Crosshouse in March 2023.

The remaining Ayr beds were moved to Crosshouse last month.

The decision sparked concern from politicians and the public who said they feared it would put the lives of patients in South Ayrshire at risk.

Claire Burden, NHSAAA's chief executive, has now set out the reasons for the decision.

Ms Burden's report reveals a key factor was the board's inability to recruit qualified intensive care specialists to work in Ayr, and says that continuing along the same path would have risked an "unplanned collapse" of the Ayr service.

The report to the Ayrshire and Arran health board said the change was "required to maintain the safety and sustainability of critical care services’.

Ms Burden went on to outline the transition that came into effect last month.

Prior to the changes, there were three ICU and four high dependency unit (HDU) beds at University Hospital Ayr. Crosshouse had nine ICU and six HDU beds.

Now there are eight HDU beds in Ayr, and 12 ICU and six HDU beds at Crosshouse.

Crosshouse Hospital (Image: BBC)

There are also other high dependency units outwith critical care services - eight of them at Crosshouse, and four in Ayr.

ICUs are required to be led by a consultant in intensive care medicine (ICM), a requirement that could not be met in Ayr, according to Ms Burden's report.

Until the changes put into effect last month, the ICU in Ayr had been led by consultant anaesthetists, a legacy from a time when intensive care was a sub-speciality of anaesthesia rather than a standalone service.

The report said that there was a national shortage of ICM consultants.

Ms Burden explained: “Doctors trained in ICM must undertake higher speciality training. Consultants who have committed to this training are more likely to seek employment in larger critical care facilities that meet modern standards.

It states that the ICU facility in Ayr was the smallest in the UK and was "therefore not attractive to consultants in ICM".

Ayr was also unusual in the fact that it was the only hospital requiring consultant anaesthetists to carry out intensive care duties, whether or not they had undergone specialist training.

Others have split rotas which allows those interested in intensive care to be involved, while others focus entirely on anaesthesia.

This was another reason for the difficulties in attracting the necessary consultants.

The new model of care will mean that only those consultants who agree to involvement in intensive care are involved in the Ayr beds.

The report continued: “The consequence of no action being taken would be a continued inability to recruit to these crucial posts.

“The potential result of a further reduction in consultant anaesthetist numbers at University Hospital Ayr (UHA) would result in an unplanned collapse of the ICU service at UHA.

"This would have a significant destabilising effect on the delivery of all critical care services across NHS Ayrshire and Arran as well as other essential services such as acute medical and surgical receiving.”

The decision to describe the move as ‘temporary’ was also addressed, with the move to be reviewed on an annual basis.

The report stated: “The decision is interim in nature insofar as it is the best feasible solutiion available to us at this time to ensure service sustainability.

"Risk assessments will continue to be made in accordance with service governance, and this interim model will be reviewed annually to confirm that it remains the best feasible option for NHS Ayrshire amd Arran.”

Patients from the Ayr Hospital catchment area who have received intensive care at Crosshouse will be transferred back to Ayr once they are deemed to no longer need that level of care.

“This will allow this patient group to continue their care closer to home,” the report added.

Concerns over the needs for patients who require emergency general surgery and arrive at Ayr Hospital were also addressed, in the report.

Ms Burden said decisions would be made on a ‘patient by patient’ basis on whether to have surgery in Ayr and then transfer to Crosshouse or be taken to directly to Crosshouse.

Around 25 patients who would have had elective surgery with potential need for ICU care post-operation will now have surgery at Crosshouse rather than Ayr.

The report continued: “It is acknowledged that these interim changes have brought with them significant uncertainty and anxiety for many of the staff involved.

“We thank them for their support and the support of partnership and trades union colleagues in delivering the essential service change.”