• Letter from Sir Bruce Keogh follows coroner warnings
  • NHS England chief executive was warned over future deaths
  • Medical director says neurosurgery patients should be admitted regardless of bed capacity

NHS England medical director Sir Bruce Keogh has warned hospitals they must not refuse patients in need of emergency neurosurgery even if they have no free intensive care beds.

Sir Bruce has today written to trust medical directors and NHS England regional medical directors, after two patient deaths were highlighted by HSJ in recent weeks.

Mary Muldowney and Teresa Dennett both needed neurosurgery but were refused transfers due to a lack of intensive care beds and delays in referrals.

Now, in response to the concern around the two cases, Sir Bruce urged medical directors to “remind your staff of the importance of adhering to the spirit of protocols associated with the transfer of neurosurgery patients”.

He pointed them to a statement by the Society of British Neurological Surgeons from 2015 adding: “This professional guidance includes recommendations that, ’admission to a regional neurosurgical unit for life-saving, emergency surgery should never be delayed and that neurosurgical units should not refuse admission to patients requiring emergency surgery from their catchment population. The lack of critical care beds must not be a reason for refusing admission for patients requiring urgent surgery.’”

Sir Bruce said that this guidance did not prevent neighbouring units from co-operating, however.

He also referred medical directors to guidance from the National Institute for Health and Care Excellence in 2014 relating to the assessment and management of head injuries.

One section refers to neuroscience units. Sir Bruce said: “This guidance includes the statement: ‘There should be a designated consultant in the referring hospital with responsibility for establishing arrangements for the transfer of patients with head injuries to a neuroscience unit and another consultant at the neuroscience unit with responsibility for establishing arrangements for communication with referring hospitals and for receipt of patients transferred’. Although this refers specifically to head injuries, the principles should apply to all emergency neurosurgical transfers.”

Earlier today the Royal College of Surgeons called on NHS England to carry out a review of critical care bed capacity. Coroners in both the cases had warned NHS England chief executive Simon Stevens that more deaths could occur.