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Random snippets and thoughts - hopefully mostly trauma related!
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The National Audit Office has just released a report on the provision of major trauma services in the UK. The report contains no new surprises - similar reports from independent bodies have been released regularly since the Ormond-Clarke report in 1961. The NAO report does mandate a hearing in the parliament Public Accounts Committee however and it is expected that some action must follow.
Some snippets from the report:
"We estimate that there are at least 20,000 cases of major trauma each year in England resulting in 5,400 deaths and many others resulting in permanent disabilities requiring long-term care. There are around a further 28,000 cases which, although not meeting the precise definition of major trauma, would be cared for in the same way. [...] We estimate that major trauma costs the NHS between £0.3 and £0.4 billion a year in immediate treatment. The cost of any subsequent hospital treatments, rehabilitation, home care support, or informal carer costs are unknown. We estimate that the annual lost economic output as a result of major trauma is between £3.3 billion and £3.7 billion."
"Despite repeated reports identifying poor practice, the Department and NHS trusts have taken very little action to improve major trauma care. Deficiencies in major trauma care were identified by the Royal College of Surgeons in 1988, but there has been little progress since. In 2007, a report by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) concluded that 60 per cent of major trauma patients received a standard of care that was ‘less than good practice’.
"As major trauma is a relatively small part of the work of an emergency department, optimal care cannot be delivered cost-effectively by all hospitals. People who have suffered major trauma often have multiple injuries which need to be treated by different surgical specialties. [...] The delivery of major trauma care lacks coordination and can lead to 11 unnecessary delays in diagnosis, treatment and surgery. There are currently no formal protocols for determining where people should be taken for treatment, nor a formal system for transferring patients between hospitals."
"The availability of rehabilitation varies widely across the country, and 14 services have not developed on the basis of geographical need. Although rehabilitation may help to reduce length of stay, minimise hospital readmissions, and reduce the use of NHS resources following the initial period of hospitalisation, it has not been considered to any great degree by strategic health authorities in their reviews of major trauma services. There is a widely perceived lack of capacity for the specialist rehabilitation of major trauma patients, but with little hard evidence about what services are currently available and how well they are arranged to meet patient needs, it is difficult to reach a conclusion on this."
The London Trauma System goes live on 1st April 2010. There is a national process in place at the moment, although there are no deadlines or deliverables for this yet. While the London system is probably secure politically, the national process is at the mercy of a change in government and policy. Both systems are at risk if some key elements of the system are not addressed, especially the financial structure for trauma and the woeful state of rehabilitation services.
The full report and executive summary are available from the National Audit Office website. The BBC has radio and TV coverage of the release, including some footage filmed with us at the Royal London Hospital.