I am a consultant in Intensive Care at Watford General Hospital and I need to draw your attention to the extreme lack of resources to care for patients with spinal injuries – “broken” necks and backs. The failure to give these, often young, patients the prompt specialist assessment and treatment they need could result in a lifetime of paralysis and all that entails. As it is, patients are left on critical care units, at up to £1800 a day, waiting immobilised for a bed at a spinal unit that never seems to materialise. The consequences of not dealing with them according to national and international recommendations could be catastrophic for the patients and expensive for the health service. Specialised spinal services were included in the Specialised Services Definition Set but the resources do not seem to be there, even if they were commissioned.
I need to stress this is not a deficiency within the Trust, trauma spinal and pelvic surgery is highly specialised, it is not a service West Hertfordshire Hospitals NHS Trust provides or should provide. In fact once we are looking after one of these patients the medical staff in particular spend an inordinate amount of time on a daily basis ringing spinal units far and wide. You are our last resort, having already contacted various individuals and medical organisations. The feedback has all been the same – there is a complete failure nationwide. Presumably, if you happen to have an accident outside St Georges Hospital for instance, you will get the care you need promptly and expertly; a very select postcard lottery.
I finish with quotes that I have received from consultants in my quest on behalf of these patients.
“and actually one of the few problems that cannot be laid at this government’s door, although in the present shambles they have not done anything constructive to address it. It is morally wrong, for example, to have a patient sitting in one of our hospitals waiting for an acute transfer to RNOH with a spinal injury for which they require specialist treatment, to be told that there is no bed in a foreseeable time frame, due to nursing staffing issues, whilst the RNOH continues to admit for elective foot and joint surgery etc. The answer is that trauma needs to be put much higher up the pecking order in political priority. It is not visible on waiting list times or league tables”
(Consultant Orthopaedic Surgeon)
“Further to your email, below are the responses from members of the College Trauma Committee. As you predicted, not very encouraging. This is one of several issues that urgently need to be addressed with the NHS and DoH and also through the political agenda.
A national problem – quite frankly these services are a shambles. “Better Care” clearly states what is needed. There is no joined up system for commissioning these services, and they do have a high priority on either the political or the various College’s agendas. Until the political climate changes I don’t really have any advice that I can give other than ‘battle on’. (A & E Consultant)
This is a national problem, made worse by the historic separation of head and spinal injuries from general hospitals. It is particularly trying in London with very limited resources – at UCLH we are supposed to have access to Queen Sq but they are rarely able to accept patients because of non-availability. (General Surgeon)
National problem, funding can be secured through pt home PCT prior to transfer but they compete for access with local 4 hour A & E target patients for beds in receiving unit. Mirrored in pelvic and acetabular injuries, plastics for open fractures etc. That’s why I included them in the first RCS report, but that was poorly put to government and media. No resolution in sight. (Orthopaedic Surgeon)
This is a national problem. Access to neurosurgical services for trauma patients is patchy at best. We can only really take those patients who require surgery not the DAI patients. Specialist commissioning does not seem to have helped so far. (Neurosurgeon)”
If you need any further information, please do not hesitate to contact me.
Dr Valerie Page