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Head injury patients get 'second rate' care
surgery
Specialist teams should always be available
Patients with head injuries are getting sub-standard care at many of the UK's hospitals, according to a report.

It recommended that only doctors specifically trained to deal with head injuries should treat such patients.

The recommendation came in a wide-ranging report from a Royal College of Surgeons of England (RCSE) working party that examined the issue for two years.

The RCSE said a million patients enter A&E departments each year with head injuries, almost half of them under 16.

But not all units have the specialist staff or equipment to deal with the injuries adequately, the report said.

The chairman of the working party told BBC News Online that this meant patients got a second rate service.

The working party called on the government to provide funding so its recommendations can be put in place within five years.

Long-term consequences

Many head injuries affect patients years after they occur, causing behavioural, emotional and physical problems.

In some cases this can lead to divorce, loss of employment and dependence on social services.

The report said: "Some 63% of adult patients who sustain moderate head injuries and 85% of patients who sustain severe head injuries remain disabled one year after their accident."

It said that even patients who suffered mild injuries continued to suffer three months later - 79% suffered persistent headaches, 59% had memory problems, and 34% were still unemployed.

"The resources available, in terms of manpower, facilities and beds, for treating these patients and for the training of the medical staff who care for them are inadequate," it said.

Recommendations

The working party recommended that any hospital that receives patients with head injuries should be adequately equipped and staffed - including 24-hour access to head scanning equipment and a specialist resuscitation team.

Patients being discharged from A&E units without further specialist treatment should be placed in the care of a competent adult who has written instructions on what to do in the event of any problems.

Those patients who have to stay in hospital for observation should be placed in a dedicated observation ward and in the care of a doctor with specialist training in dealing with head and brain injuries.

A&E specialists and neurologists were the only doctors suited to this role, and resources should be made available to phase out the use of general surgeons and orthopaedic surgeons in this position as modern training made them unsuitable for such work, the report said.

Current practice failings

However, many A&E departments fall short of these standards.

The working party looked at surveys of various hospital departments. It found that:

  • 85% of patients with moderate injuries - defined as an injury requiring the patient to stay in hospital for 48 hours - were cared for by general or orthopaedic surgeons
  • Just under four-fifths of departments had 24-hour access to head scanning facilities
  • Only 38% of departments had short-stay observation units
  • 70% had no access to brain specialists on site, and at 20% of A&E units A&E specialists were not allowed to refer patients directly to neurosurgeons

Quality concerns

Professor Charles Galafko, who chaired the working party, said the team had set out to establish the current situation in A&E units and found deficiencies across the board.

Asked whether it was realistic to expect the government to fund all the recommendations, he said quality of care was the central issue.

"It all depends on what quality of service you want - so the average NHS patients gets optimum results or not a quality service where patients do not."

At the moment patients were getting a second rate service, he said.

"The government has made money available to improve A&E - we hope they'll use it to address these deficiencies."

A Department of Health spokeswoman said: "The department accepts the need for specialised rehabilitation services for people recovering from brain injury.

"In some cases these can be provided locally and involve collaboration between health, personal social services, further education and employment services."

She said the department would issue a circular on the treatment of head injuries later in the year.

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BBC News' James Westhead reports
See also:

01 Aug 98 | Health
21 Sep 98 | Health
28 Jan 99 | Health
18 Feb 99 | Health
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