Managers should improve job planning to limit a huge drop in the quality of trauma care at night.

A damning report published yesterday says the fall in standards at night is linked to the fact that most night shifts are covered by junior and inexperienced staff.

The Trauma: Who Cares? report by the National Confidential Enquiry into Patient Outcome and Death found less than half of patients received good care overall.

Enquiry clinical co-ordinator Dr George Findlay, one of the authors, said one problem was 'a culture throughout the NHS that consultants by and large provide daytime services'.

The confidential enquiry team reviewed nearly 800 trauma cases at more than 180 hospitals over a three-month period. They uncovered a raft of failings including poor care at trauma scenes, incorrect clinical decisions, and 'haphazard' transfers of critically ill patients.

The report showed not all hospitals had the resources to offer top quality trauma care, which is why it calls for regional planning, said Dr Findlay. This could see some hospitals become specialist trauma centres, which echoes junior health minister Lord Darzi's vision for the future of the NHS but is often locally unpopular.

He added it was vital for hospital trusts and ambulance services to work more closely together on ways to improve pre-hospital trauma care, which could include more doctors on ambulances or more training for paramedics.

Karim Brohi, consultant trauma and vascular surgeon at the Royal London Hospital, which has a good record on trauma, said the case for regional planning was clear.

He said managers at larger multi-specialism hospitals should consider investing in staff and facilities to become 'trauma centres of the future'.

Meanwhile, smaller hospitals should look at ways they could collaborate with larger centres.

He also highlighted a need for primary care trusts and strategic health authorities to actively pursue high standards in trauma care 'just as has been done for cancer'.

The surgeon said: 'We need exactly the same thing for trauma because it is killing just as many people as cancer and they are younger people.'