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According to a National Audit Office report published on 5 February 2010, there is unacceptable variation in major trauma care in England depending upon where and when people are treated. 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 with services not being delivered efficiently or effectively.
The report reveals that 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. It is estimated that 450 to 600 lives could be saved each year in England if care was managed more effectively.
For the best outcomes, care should be led by consultants experienced in major trauma. However, 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.
The report argues that 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 but a significant number of patients needing a scan do not receive one and not enough patients who need a critical care bed are given one.
Similarly, the NAO contends that 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% of hospitals delivering major trauma care contribute to the Trauma Audit and Research Network (TARN). The performance of the 40% of hospitals that do not submit data to TARN cannot be measured.