A new report finding failings in the treatment of elderly people with surgical emergencies such as hip fractures and abdominal problems makes a potent case for change in NHS hospitals, but recommendations will not be applied without commitment from the highest level in NHS Trusts. This is the view of a coalition of medical organisations including the Royal College of Surgeons [RCS], British Orthopaedic Association [BOA], Association of Surgeons of Great Britain and Ireland [ASGBI] and British Geriatrics Society [BGS].
The NCEPOD report, An Age Old Problem, adds to a series of reports from surgical associations which have already identified problems in the organisation of emergency surgery services in UK hospitals and made steps to remedy. Recent initiatives include:
- In 2007, the BOA and BGS established the National Hip Fracture Database [NHFD] to systematically record exactly the standards in care highlighted by NCEPOD. The NCEPOD report analyses a snapshot of 302 hip fracture cases in 2008 and the latest NHFD report of 36,000 hip fracture cases in September 2010 shows significant progress on many of the problems identified.*
- A report from the ASGBI in June 2007 (Emergency General Surgery: The Future) sent to every NHS Trust highlighted how joined-up care could not be delivered via reliance on on-call consultants and warned that “…emergency admissions often takes second place to the care of elective patients. This will only be resolved if emergency admissions have dedicated resources…”.**
- In December 2008, the BOA highlighted how their surgeons were concerned that their hospital were failing elderly patients with hip fractures with only 20 per cent saying their unit met BOA guidelines.***
- In 2007, the RCS produced a detailed report recommending the separate organisation of emergency and elective surgery to ensure both sets of patients get tailored care.****
Clare Marx, past-President of the BOA and RCS lead on patient safety said: “Clinicians have lead by setting clear standards for these older patients and auditing how hospitals meet them. Colleagues have reported a big improvement in the delivery of fracture care since the introduction of new tariff that financially reward hospitals who provide high quality care. This demonstrates that, in complicated organisations like hospitals, if the right levers are pulled and managers take responsibility for patient outcomes alongside the clinical teams things can improve very quickly.”
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.”
Finbarr Martin, President of British Geriatrics Society: “The NCEPOD report documents sad examples of precisely why our initiatives with the BOA were needed and will continue to be vital in the coming years. However we are optimistic as the 2010 NHFD report showed definite quality improvement since the period examined by NCEPOD. Since then a national network of anaesthetists for elderly trauma patients has also been set up. We now need commission action to promote the changes we have advocated. Emergency surgery is a multidisciplinary challenge and all disciplines involved must be trained and resourced sufficiently to get this right for older people.”
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.”
- Ends -
Notes to Editors
- *For full details of the National Hip Fracture database go to: http://www.nhfd.co.uk/
- **ASGBI, Emergency General Surgery: The Future – A Consensus Statement.
- **Full details of the BOA standards for care of trauma patients with hip fractures are laid out in the "British Orthopaedic Association Standards for Trauma (BOAST): Hip Fracture in the Elderly Person" and "The Care of Patients with Fragility Fractures (“Blue book”)".
- ****Separating Emergency & Elective Surgical Care: recommendations for Practice: http://www.rcseng.ac.uk/publications/docs/separating_emergency_and_elective.html
- The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808. For more information please visit www.rcseng.ac.uk
- The Association of Surgeons of Great Britain and Ireland (ASGBI) is an association representing general surgery and all its related specialities throughout the United Kingdom and Ireland.
- The BOA is the professional association for trauma and orthopaedic surgeons in the United Kingdom and those abroad who have had orthopaedic training in the UK or who show a continuing interest in the affairs of the Association.
- The British Geriatrics Society is a multi-disciplinary professional membership association that seeks to promote better health and care for older people. We do this by holding scientific meetings, producing clinical guidelines, sharing best practice and acting as an ‘expert voice’ on the care of older people and promoting better health in older age. We have over 2,500 members including doctors practicing geriatric medicine, old age psychiatrists, general practitioners, nurses, therapists and scientists. For more information please visit www.bgs.org.uk
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