• NHS England report highlighted “wholly unacceptable” delays in treatment for spinal patients
  • Report found 54 more specialist spinal beds were needed, but separate data suggests situation remains largely unchanged
  • Commissioner criticised by charity and parliamentary body

Spinal patients have been exposed to “avoidable harm” due to “wholly unacceptable” delays in their treatment, according to an unpublished NHS England report.

HSJ has seen an internal review by the national commissioner that highlighted the issues two years ago, and which recommended 54 additional specialist beds were needed to address the problems.

However, separate bed data has suggested the situation remains largely unchanged, prompting concerns from a leading charity and the all-party parliamentary group on spinal cord injury.

Unpublished national bed data for 2017-18, the year after the review, suggested just two additional beds were commissioned across all eight spinal cord injury centres in England, which brought the total number of beds to 395 (see breakdown below).

HSJ has not seen bed numbers for 2018-19, but, when contacted, none of the trusts which provide these services indicated their beds numbers had increased.

Baroness Masham of Ilton, who is secretary of the APPG and president of the Spinal Injuries Association, said: “By not making progress on these recommendations patients are being failed year after year by not receiving the specialist care they need.

“The Department of Health and Social Care and NHS England must get their act together and start making clear plans on how and when the extra beds will be delivered.”

Neither NHS England nor the DHSC have responded to HSJ’s questions about the review and any subsequent actions.

The review, which was completed in December 2016 and was recently shared with HSJ, said patients with spinal cord injuries waited an average of 52 days for a bed on a specialist ward in 2015-16, and almost three months if the patient required ventilation.

It added: “These delays expose patients to avoidable harms and are wholly unacceptable. Delays in transfer impinge on the functioning of the major trauma centres and result in significant distress to patients and increasing institutionalisation. This is a very serious failing of the fundamental role of the spinal cord injury service.”

No waiting times data has since been published but the unpublished data for 2017-18, also seen by HSJ, suggested six out of eight centres had seen an increase in referrals.

A source close to the process suggested the 2016 review had not been published because of concerns NHS England’s specialised commissioning division would be unable to fund the recommendations.

The review also said delays in admissions were “causing significant difficulties” for major trauma centres, as the lack of specialist capacity meant patients were “inappropriately” occupying beds at these centres. It suggested this had a cost impact of up to £20m nationally.

The delays also meant that some patients did not receive any specialist centre care.

Chair of the charity Spinal Injuries Association, Rupert Earl, suggested the issues have not been resolved in the two years since.

Dr Earl said: “We are gravely concerned that the demand for specialist spinal cord injury beds and rehabilitation care – that we know makes such a huge difference to people’s future life chances after injury – is not being met. In a [November 2018] national statement on SCI services in England, of the 2,494 referrals in 2017-18 to specialist SCI centres, just 800 were admitted and a great many more SCI patients were not referred at all.

“As a result, we are hearing that major trauma centres are being forced to provide rehabilitation services for their SCI patients and we are also hearing of units who do not refer to SCI centres on the basis that they rarely if ever get any patients accepted in.”

The review also called for a national spinal injury board to standardise and improve patient outcomes nationally. It is not clear how far, if at all, its creation has progressed.

It also criticised the commissioning process, saying there were “different approaches in different (regional) centres” because “there is no clear national strategic planning”.

Spinal injury unit No. of beds commissioned 2017-18
Salisbury Foundation Trust 39
Royal National Orthopaedic Hospital Trust (Stanmore) 40
Buckinghamshire Healthcare Trust (Stoke Mandeville) 103
Robert Jones and Agnes Hunt Orthopaedic Hospital (Oswestry) 44
Southport and Ormskirk Hospital Trust 51
Sheffield Teaching Hospitals FT 60
The Mid Yorkshire Hospitals Trust (Wakefield) 34
South Tees Hospitals FT (Middlesborough) 24

The review also revealed a stark north-south divide. Of the 54 new beds the report recommended, it advised 38 should be located in south London by the creation of a new specialist centre. It said this would end the “gross disparity” between bed capacity and regional variation, which has left patients facing far longer waits in the south.

In 2015-16, patients waited an average of 72 days to access one of the three centres in the south, and 33 days to access one of the five centres in the north. In 2015-16, one patient waited almost a year (313 days) for admission to the Stoke Mandeville Hospital’s specialist unit.