Regions must earmark hospitals as major trauma centres that can be forced to accept seriously injured patients, the trauma czar has said.

Keith Willett, who became national clinical director for trauma last month, said strictly defined trauma networks must be set up and supported by changes to the commissioning and payment system.

At present, patients are often treated in the wrong hospital because others, with better specialist services, refuse to take responsibility for them, he said.

Trauma services were “deficient in many cases”, according to a 2007 National Confidential Enquiry into Patient Outcome and Death report, and Professor Willett said they remained poor in many areas of England.

He plans to set rules defining when a patient becomes a major trauma case and will ask regions to design networks with specialist centres to treat them.

Care of major trauma patients will be commissioned by the networks, forcing centres to take patients. Professor Willett said: “At the moment the specialist centre has no incentive [to take patients] - and it has to respond to targets and things.

“We need to be commissioning a network. As soon as it is identified that a patient exceeds the capacity of an individual hospital it needs to become a network responsibility.”

Professor Willett, professor of orthopaedic trauma surgery at Oxford University and consultant orthopaedic trauma surgeon at Oxford Radcliffe Hospitals trust, will ask regions to collect information on trauma patients to use for designing networks.

He said the process would not be complete before April 2011, when NHS investment levels are to decrease, so could not rely on expensive reconfiguration.

National Confidential Enquiry chief executive Marissa Mason said: “The NHS needs to know how to deal with trauma patients and have something in place that says, ‘If you cannot deal with them, send them where they can.’”

Professor Willett also said significant savings can be made in fragility fracture services by reducing bed days and improving prevention.