Warning: leading specialist Robert Bentley
The “unqualified success” of major trauma centres is being undermined by a shortage of community rehabilitation beds, one of London’s top doctors has warned.
Robert Bentley, director of trauma at King’s College Hospital, said specialist centres were becoming blocked because of difficulties in “repatriating” recovering patients to their local hospital.
On one occasion last month he was unable to operate on two patients requiring skull reconstruction because of competing demand from surgeons treating cancer patients.
He called for a system of conjoined commissioning to ensure NHS officials who were happy to send patients to a major trauma centre such as King’s also ensured there was funding for rehabilitation closer to home.
He said there had been unintended consequences of setting up 26 trauma centres across the country in 2012, which began with the launch of four major trauma centres in London in 2010 — at King’s, St Mary’s, St George’s and the Royal London.
They were set up to give patients 24/7 access to consultants and faster access to diagnostic scans, increasing their chances of survival and lowering the risk of permanent disability.
But up to one in five trauma patients may not be “time critical”, meaning they have to effectively compete with other patients for specialist care.
His research found 45 per cent of patients did not get the correct level of rehabilitation after leaving a trauma centre, while 70 per cent did not receive it at the correct time or close enough to home.
Similar problems have been reported by Barts Health in finding “step down” beds for recovering patients from the Royal London hospital.
Of the trauma network, Mr Bentley said: “It’s been an unqualified success ... In two years we have reduced mortality by 30 per cent in the biggest killer under 40. That is staggering.”
But he added: “All of these patients coming in were never commissioned to go out. The bath is full up and there is no outflow. If there is one system where the wheels fell off the wagon, it was major trauma. If we don’t flow patients, if we don’t let the ‘water out of the bath’, we are dead.”
Mr Bentley, a consultant cranio-oral and maxillofacial surgeon, was named as one of the Evening Standard’s 1,000 most influential Londoners for his work at King’s and the campaign to build a £3.5 million air ambulance helipad at the hospital. It needs about £1 million to reach its target.
Dr Anne Rainsberry, NHS England’s London regional director, said efforts were being made to improve the flow of patients, with a dedicated team set up in south-east London to manage the return of patients to local hospitals.
Published: 12 January 2015