Page last updated at 00:08 GMT, Friday, 5 February 2010

NHS trauma services in England 'not good enough'

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Professor Karim Brohi of the Royal London Hospital explains why reorganising trauma care is important

Adam Brimelow
Health correspondent, BBC News

Hundreds of people who suffer serious injuries are dying due to poor care, according to the National Audit Office.

A report found the death rate in England for major trauma patients is 20% higher than in the United States.

The NAO also concluded that services had barely improved over the past two decades, despite there being repeated calls for reform.

The government said changes are now under way that will transform the emergency service.

There are 20,000 major trauma cases in England every year - patients with serious injuries, often from road accidents, falls or burns.

I think there's very good evidence now that if we carry on as we are, with the sickest people in the hospital being looked after by the most junior doctors, you get poor outcomes
Professor Karim Brohi,
Royal London Hospital

Trauma is the biggest cause of death in people under 40 and the numbers are growing.

The NAO said as far back as 1988 studies identified deficiencies in care.

But its report concludes there is little sign of progress, citing recent evidence that a majority of cases are not handled well.

The analysis found survival rates vary significantly from hospital to hospital, and that between 450 and 600 lives could be saved each year in England if major trauma care was managed more effectively.

Too often patients with severe injuries are taken by ambulance to the nearest casualty department, rather than the hospital with the equipment and expertise to cope with these complex cases, the report found.

And care should be led by consultants experienced in major trauma, who can provide "quicker and better decision-making".

But evidence suggests that happens in only 40% of cases, putting patients in the hands of junior doctors who may not have the equipment or expertise available to provide appropriate treatment.

Trauma networks

The report also criticised delays in access to crucial CT scans, as well as surgery and rehabilitation.

Amyas Morse, head of the National Audit Office, said: "Current services for people who suffer major trauma are not good enough.

"There is unacceptable variation, which means that if you are unlucky enough to have an accident at night or at the weekend, in many areas you are likely to receive worse quality of care and are more likely to die.

"The Department of Health and the NHS must get a grip on co-ordinating services through trauma networks, on costs and on information on major trauma care, if they are to prevent unnecessary deaths."

Health Minister Mike O'Brien said regional trauma networks were being introduced.

"These aim to ensure patients are delivered safely and rapidly to a specialist hospital where teams of experts, including trauma, orthopaedic and neuro-surgeons are on hand to care for patients 24 hours a day, seven days a week."

Currently only a minority of emergency departments have adequate consultant numbers to achieve a consultant presence beyond much more than 'normal office hours'
Don MacKechnie,
Vice president of the College of Emergency Medicine

The report commends the trauma plans for London, with major centres at the Royal London and three other hospitals.

Death rates at the Royal London have fallen by nearly 50% since it introduced better co-ordination between ambulances, the emergency department, surgery and rehabilitation services.

Consultant surgeon, Professor Karim Brohi, says patients across the country could benefit from their example.

"I think there's very good evidence now that if we carry on as we are, with the sickest people in the hospital being looked after by the most junior doctors, you get poor outcomes.

"Having experienced, trained consultants in emergency medicine, intensive care and surgery available for these patients when they come in so the right decisions are made and the right treatment is given makes a significant improvement."

The College of Emergency Medicine welcomed the report.

Vice president Don MacKechnie said: "Currently only a minority of emergency departments have adequate consultant numbers to achieve a consultant presence beyond much more than 'normal office hours'.

"This report provides further evidence of why such investment is so imperative."



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