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Experts criticise emergency care of elderly

Geriatricians and surgeons condemn failings in emergency care of the elderly

Louise Prime

Friday, 12 November 2010

Overemphasis on bringing down waiting lists for routine procedures has left the elderly poorly treated for emergencies such as hip fracture and abdominal problems, claim specialists.

A coalition of the Royal College of Surgeons (RCS), British Orthopaedic Association (BOA), Association of Surgeons of Great Britain and Ireland (ASGBI) and British Geriatrics Society (BGS) argue that the latest report, An Age Old Problem, from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) doesn’t go far enough in its criticism of the current system or recommendations for change.

Although the NCEPOD report makes a strong case for change in the NHS, in order to address the current failings it has found in the treatment of elderly people with surgical emergencies such as hip fractures and abdominal problems, the coalition says these recommendations will not be applied “without commitment from the highest level in NHS Trusts”.

Several recent reports from surgical associations had already identified problems in the organisation of emergency surgery services in UK hospitals. The ASGBI warned every NHS Trust in June 2007, in its report Emergency General Surgery: The Future, that “… emergency admissions often take second place to the care of elective patients. This will only be resolved if emergency admissions have dedicated resources…”. The ASGBI said at the time that coordinated care could not be delivered via reliance on on-call consultants.

Then 18 months later, the BOA revealed further failings – only 20% of surgeons said their unit was meeting BOA guidelines on the care of elderly patients with hip fractures.

Mike Horrocks, president of the ASGBI, said: “In recent years, the NHS has been set targets for elective operations to bring down waiting lists. This has been fantastic for patients with non-emergency conditions, but come at the detriment of those who require urgent treatment as hospitals focused on hitting those targets. The new government have committed to moving away from targets and towards measuring and rewarding hospitals who deliver good outcomes and this report should provide further evidence that this approach is correct.”

John Black, president of the Royal College of Surgeons, said: “This report from NCEPOD provides strong independent data which backs up what surgeons have been saying for some time – emergency surgery is a Cinderella service in the modern NHS.

“The RCS heartily agree with the report recommendations but are disappointed they were not ambitious enough. Asking for clinical directors to take these forward is preaching to the converted – we will only solve these problems if focusing on emergency care becomes a priority in the boardroom as well as the ward.”

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