There are more than 500 avoidable deaths a year in emergency care each year in London, a report obtained exclusively by HSJ reveals.
The report from 26 of London’s most senior clinicians points to “stark” differences in consultant hours across the capital’s hospitals at evenings and weekends, and names those with the patchiest cover.
The draft document said: “If the weekend mortality rate in London was the same as the weekday rate, there would be around 520 fewer deaths. Reduced service provision at weekends is associated with this higher mortality rate.”
The report, “Acute medicine and emergency general surgery – case for change”, was compiled for NHS London in the spring and presented to a private meeting of the strategic health authority last month.
The clinicians asked trusts to rate themselves on several key indicators relating to emergency care and found huge disparities from trust to trust.
While the Hillingdon Hospital and Croydon Health Services expected an on call consultant emergency general surgeon to be on site for 12 and nine hours a day, respectively, over the weekend, King’s College and Newham University hospitals had cover for only two hours.
Across London, consultant emergency general surgeons were on site for an average of four hours a day at the weekend, compared to 10 in the week.
The report said: “In London, there is significant variation in the number of hours that a consultant is expected to be on-site, some are not freed from elective surgery commitments to carry out emergency work and surgical trainees are often not supervised out-of-hours.
“The survey of acute trusts also found that there is inadequate access in almost a third of London’s hospitals to an emergency theatre – this is detrimental to patient outcomes and can increase mortality and morbidity,” it warned.
See the data broken down by London hospital - right
- How many hours is the on-call consultant energency general surgeon expected to be on site each day? - Pg.14
- Does the hospital offer an emergency general surgery service on site? - Pg.10
- Are all emergency surgery admissions reviewed by a consultant within 12 hours of admission? - Pg.18
- Are appropriate emergency cases operated on within 24 hours of admission? - Pg.21
- Do limitations on imaging or theatre capacity prevent patients having emergency surgery on the day they should? - Pg.23
- How many hours is the admitting medical consultant expected to be on site each day? - Pg.33
The report is likely to exacerbate tensions around reconfiguring London’s acute services, with the closure of accident and emergency units often leading to public demonstrations.
Sixteen of the 31 hospital emergency units in London are part of a trust considering merger or reconfiguration.
The study found three of the 31 – Epsom Hospital, Central Middlesex Hospital and Hammersmith Hospital – did not have an emergency general surgery service on site.
The Royal College of Physicians recommends that consultant-level review of acute patients be available at all times – but the survey found only six hours of on-site cover at the weekend in London, compared to 11 hours in the week.
St Thomas’ Hospital and King George Hospital both reported three hours of on site cover at the weekend, while Chelsea and Westminster and North Middlesex had on site cover for 12 and 11 hours, respectively.
The report said: “The key to change lies in adaptation of working practice to ensure greater availability of senior medical leadership.
“Many medical directors stated that this was a journey that their trusts had embarked upon, with the co-operation of consultants, in developing dynamic working practices that were responsive to patient needs. Others, however, admitted that they remained locked into traditional and often inflexible models.”
Another variation revealed by the report is how soon emergency surgery admissions are seen by a consultant.
Asked whether they “sometimes”, “very often” or “always” had emergency surgery admissions reviewed by a consultant within 12 hours of admission, only four reported this “always” happened, regardless of the time of day or of the week.
These were Croydon University Hospital, North Middlesex, Charing Cross and Hammersmith hospitals.
Four trusts – St George’s, The Whittington, Newham University Hospital and King George Hospital – answered “sometimes” for the entire week.
A spokesman for NHS London said: “This review focused on adult acute medicine and general services – the care adult patients receive on a general ward after being admitted for emergency treatment. The review therefore excludes patients treated in London’s four major trauma centres (St George’s, King’s College, the Royal London and St Mary’s).”
- Acute care
- ACUTE LIST
- BARKING, HAVERING AND REDBRIDGE UNIVERSITY HOSPITALS NHS TRUST
- CHELSEA AND WESTMINSTER HOSPITAL NHS FOUNDATION TRUST
- Croydon Health Services NHS TRUST
- Emergency care
- EPSOM AND ST HELIER UNIVERSITY HOSPITALS NHS TRUST
- GUY'S AND ST THOMAS' NHS FOUNDATION TRUST
- IMPERIAL COLLEGE HEALTHCARE NHS TRUST
- London North West University Healthcare NHS Trust
- Mortality rates
- NEWHAM UNIVERSITY HOSPITAL NHS TRUST
- NORTH MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST
- Royal College of Physicians
- St George’s University Hospitals NHS Foundation Trust
- THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST
- Whittington Health NHS Trust