Page last updated at 23:36 GMT, Wednesday, 17 September 2008 00:36 UK

Targets 'damage NHS trauma care'

Emergency care
Trauma patients can face delays, doctors say

The NHS in England is failing to provide adequate care to some of the most severely injured patients because of targets, leading doctors have said.

The Royal College of Surgeons and British Orthopaedic Association said some trauma patients - many from road accidents - faced delays to surgery.

This was because transfers to hospitals with specialist trauma teams were delayed by local targets, they claimed.

The government admitted failings, but said reform was in place.

The two organisations pointed out that prompt surgery for complex injuries, such as pelvic and hip socket fractures which are common in road accidents, was essential.

The current system does not work
Professor Chris Moran
British Orthopaedic Association

They said treatment - which includes the initial stabilising of the fracture followed by the final fixing and setting a few days later - within seven days meant that 80% of patients could recover with excellent results, avoiding disability.

But after 10 days that figure dropped to 50% and by three weeks it stood at almost zero.

They said previous research showed NHS hospitals reported an average of between 10 and 20 days.

Trauma patients often require transfer to hospitals with specialist trauma teams.

But the doctors said these teams often struggled to accept new patients because of the demands placed on them by targets.

These include ensuring local patients are out of A&E within four hours and that planned elective surgery cases are not cancelled.

As a result, doctors said, patients with serious injuries can be left marooned in an inappropriate hospital, facing long delays for surgery.

The report said it would be better if the NHS was organised into trauma networks so each region had specialist centres that could focus on this type of care - something the government is already working towards.

At the moment, specialist teams are spread more thinly across a larger number of hospitals.

Trauma policy

The report comes after a study last year found many services were not good enough.

We recognise that trauma services fall short of what should be expected
Department of Health

The National Confidential Enquiry into Patient Outcome and Death analysis of trauma care in 200 hospitals found staff often did not appreciate the severity of the condition and displayed little urgency.

It also found arrangements to transfer patients between hospitals were often "ad hoc".

Professor Chris Moran, of the British Orthopaedic Association, said: "The current system does not work.

"Patients are frequently denied access because the units are already full and are instead stuck on hidden waiting lists until a bed becomes free.

"These patients are not a priority as units are under no obligation to take on emergency cases from another hospital."

A Department of Health spokesperson said: "We recognise that trauma services fall short of what should be expected.

"That is why the NHS is now taking forwarded the development of trauma centres and we are appointing a specialist 'trauma tsar' to lead nationally on trauma policy.

"It is not the case that trauma care suffers because priority is given to elective surgery. It is not an either or."

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