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Major trauma care service is lamentable

Shocking care after major trauma still leads to hundreds of unnecessary deaths

OnMedica staff

Friday, 05 February 2010

The standard of care provided to patients in England who suffer major trauma has been condemned in a report published today by the National Audit Office. The NAO’s head, Mr Amyas Morse, said the problems are exacerbated at night and at the weekend.

The NAO finds that little action has been taken since 1988 when the Royal College of Surgeons warned the Department of Health and NHS Trusts about deficiencies in the care of severely injured patients. In 2007 the National Confidential Enquiry into Patient Outcome and Death concluded its own report by saying that 60% of major trauma patients received a standard of care that was "less than good practice".

The NAO says there is evidence that having a dedicated consultant present in an emergency department produces quicker and better decision-making in the care of major trauma patients. Major trauma occurs more frequently at night-time or at weekends, but the report says consultants are most likely to be present only between 8am and 8pm Monday to Friday, with night-time and weekend cover provided on an on-call basis. Only a single hospital has 24-hour consultant presence seven days a week.

“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,” said Mr Amyas Morse, head of the National Audit Office.

He added: “The Department of Health and the NHS must get a grip on coordinating services through trauma networks, on costs and on information on major trauma care, if they are to prevent unnecessary deaths.”

There are about 20,000 cases of major trauma each year in England – most commonly arising from road accidents – that result in 5,400 deaths, and in permanent disabilities requiring long-term care. Survival rates for major trauma vary significantly between hospitals, reflecting variations in the quality of care.

The NAO says major trauma care is uncoordinated, with no formal arrangements for taking patients directly for specialist treatment or transferring them between hospitals. And although CT scanning is very important for major trauma patients, a significant number of patients who need a scan do not receive one.

Edward Leigh MP, chairman of the Committee of Public Accounts, has issued a damning indictment of the NAO’s findings: “Major trauma services are currently provided in a disorganized and uncoordinated fashion. It cannot be beyond the capabilities of the Department and NHS Trusts to establish a system, at little extra cost, enabling seriously injured patients to be delivered quickly to those parts of the health service best equipped to treat them.

He said: “For more than 20 years almost nothing has been done to remedy the lamentable provision of care for people suffering serious injuries.

“The shocking truth is that an estimated 450 to 600 lives are being unnecessarily lost each year because of poor care. If you have an accident at night or over the weekend, you are unlikely to be seen immediately by a consultant, given that only one hospital in the entire country has the required specialist consultant care 24 hours a day, for seven days a week.

“This means that your chances of avoiding death or disability can turn on when your accident happens and to which hospital the ambulance takes you. Some hospitals have the appropriately trained surgeons for major trauma, many do not; and some areas have formal bypass arrangements for ambulances, but many do not.”

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