There is unacceptable variation in major trauma care in England depending upon where and when people are treated, according to a National Audit Office report published today. Care for patients who have suffered major trauma, for example following a road accident or a fall, has not significantly improved in the last 20 years despite numerous reports identifying poor practice, and services are not being delivered efficiently or effectively.

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Survival rates vary significantly from hospital to hospital, with a range from five unexpected survivors to eight unexpected deaths per 100 trauma patients, reflecting the variable quality of care. The NAO estimates that 450 to 600 lives could be saved each year in England if major trauma care was managed more effectively.

For best outcomes care should be led by consultants experienced in major trauma; but major trauma is most likely to occur at night and at weekends, when consultants are not normally in the emergency department. Only one hospital has 24-hour consultant care, seven days a week.  

Major trauma care is not coordinated and there are no formal arrangements for taking patients directly for specialist treatment or transferring them between hospitals. CT scanning is very important for major trauma patients; however, a significant number of patients that need a scan do not receive one. Not enough patients who need a critical care bed are given one.

Access to rehabilitation services, which can improve patients’ recovery, quality of life and reduce the length of hospital stay, varies across the country and patients are not always receiving the care that they need. The costs of major trauma care are not well understood. The estimated annual lost economic output from deaths and serious injuries from major trauma is between £3.3 billion and £3.7 billion.

Collecting information on care is essential for monitoring and improving services, but only 60 per cent of hospitals delivering major trauma care contribute to the Trauma Audit and Research Network (TARN). The performance of the 40 per cent of hospitals that do not submit data to TARN cannot be measured.  

"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 coordinating services through trauma networks, on costs and on information on major trauma care, if they are to prevent unnecessary deaths."  

Amyas Morse, head of the National Audit Office


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