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Health: Severe Trauma

Volume 697: debated on Monday 7 January 2008

asked Her Majesty’s Government:

Whether they have any plans to improve the care of trauma patients in hospital accident and emergency units.

My Lords, my noble friend refers to severe trauma. Studies indicate that there are 3,000 to 4,000 such cases each year in the UK. The majority of hospitals see less than one severely injured patient per week. However, evidence suggests that seeing more cases leads to better outcomes.

In the NHS Next Stage Review, clinicians in nine strategic health authorities are discussing the best models of care available to us on the current evidence, including acute care, which would lead to improved trauma services.

My Lords, I thank my noble friend for that response. What is the Government’s attitude to the report Trauma: Who cares?, which states that of the severely injured people who attend hospital, more than 50 per cent receive poor care? If that allegation is true, it is a shocking situation, which the Government should not put up with for a moment. What are they doing about the report? Is it a fact that more than 50 per cent of such people receive poor care in National Health Service hospitals, which are the department’s direct responsibility? When will the proposed changes to improve the situation be carried out? Finally, will the Government now consider setting up an inspection unit to make sure that we do not go back to the old system of people being killed in hospital rather than cured or that they do not go into hospital expecting to be cured but are killed?

My Lords, my noble friend raises a very important issue. Severe trauma is a global health challenge. The incidence of severe trauma is four per million of population in the UK. However, it is the eighth leading cause of death in the developed world and the fourth cause of so-called DALY, the disability adjusted life years. In the NHS Next Stage Review, trauma services and their development in England is one of the priorities in the acute pathway. Let me put it in the context of the capital’s strategic health authority: London sees the largest number of traumas when it comes to both blunt and penetrating injuries. The recommendations of the London report are for three trauma centres in London which will provide not just care but the ultimate quality of care to which my noble friend refers.

My Lords, what plans are there to increase pre-hospital capability with specialist care and consultants specifically trained in on-site care and triage to increase survival? We know that secondary transfer is often a cause of death. Eighty-five per cent of these patients are young men, and it is the commonest cause of death in men under 40.

My Lords, the noble Baroness highlights some of the recommendations of the NCEPOD pathway which suggests that pre-hospital care should be significantly enhanced. At the place of the incident, ambulance services should be able to intubate and ventilate patients and make the right decision to transfer them to the right centre where there is a multidisciplinary team to deal with major traumas. As I said earlier, severe trauma is the eighth leading cause of death, and it is younger people who suffer most of the injuries.

We have taken on board the recommendations of NCEPOD, not necessarily just regarding pre-hospital admission. We also need to have, and define for the first time, dedicated regional trauma centres. It is the one area where there is clear evidence that centralisation of services, with adequate competencies at the site of receiving hospitals, will significantly impact on the quality of care.

My Lords, will the Minister give us some sort of encouragement to believe that in the next stage of the review there will be adequate consultation? It is fine for him to say that there will be three trauma centres in London, but in a huge area such as West Sussex—I declare an interest, being a resident there—there is anxiety about the lack of consultation and the apparent reluctance of the National Health Service trust to take into account the views of the people of West Sussex about cutting down on trauma centres. Although it is not right that every hospital should have a trauma centre, we wish to have confidence in the consultation process.

My Lords, I agree with the noble Baroness. As we speak, a significant consultation is going on in London with regard to the recommendations of the London framework, including the provision of three trauma centres. I wish to wait for the outcome of that consultation.

We need to separate consultations relating to A&E and emergency services from those relating to major trauma, which is what we are referring to here. Major trauma is defined as having an injury severity score of greater than 16. Each of the hospitals we are referring to receives no more than one case a week. This is a separate cohort of patients. Because of the rarity of such presentations, we strongly believe that we should have dedicated trauma centres that will create an adequate network to receive patients from more rural areas.

My Lords, will the Next Stage Review address the fact that standards of care for patients transferred between hospitals have not improved over the past five years, despite a major injection of funds into that service?

My Lords, the Next Stage Review has already identified that if we are to reform clinical services, the transfer of patients who have been pre-assessed at the place of presentation and taken to the right place at the right time is vital if clinical reform is to work. Otherwise, we will continue to have the wrong patients arriving at facilities that will not be able to cope with their presentations. We are injecting into our ambulance staff significant amounts of not just funding but training. Ambulances are no longer simply transport systems; they are treatment centres. And let us not forget the air ambulance service that will complement some of these services.