Review of acute medicine and emergency general surgery services

September 21, 2011

A report setting out the need for change in hospital care for emergency patients and new clinical standards has been published today by NHS London and London Health Programmes.

Evidence put forward by leading clinicians suggests that increasing the number of hours hospital consultants are available at weekends and improving access to diagnostic scans could save more than 500 lives every year in London.

More than half a million patients are admitted to a London hospital as an emergency every year.  They should expect to receive consistently safe, high quality care. However, new figures show that patients admitted at the weekend have a significantly increased risk of dying compared to those admitted on a weekday.

Dr Andy Mitchell, Medical Director at NHS London, said: “The reasons for differences in mortality rates during the week compared to the weekend are complex.  However, we know that one of most important factors in improving outcomes for patients is to be assessed by an experienced consultant as quickly as possible.  In some cases this happens, but our review found that many hospitals in London had insufficient consultant cover, particularly at weekends.

“We want patients in London to have access to the same, high-quality and reliable services 24 hours a day, seven days a week – after all, patients cannot always choose when they will need NHS care in an emergency.  Continuing to give patients poorer care at the weekend is not an option.  Every avoidable death is one too many.  This is not a London-specific problem but we are leading the way to find a solution. The improvements we have achieved with stroke and cardiac care should be extended to all patients, no matter what their underlying condition.”

A panel of GPs, physicians, surgeons and nurses has now developed new commissioning standards to provide high-quality and safe hospital care across every day of the week, including weekends.  This follows an extensive review of the quality of care inpatients receive in hospital and discussions with patient groups.  These standards include the need for all emergency patients to be seen and assessed by a consultant within 12 hours of being admitted to hospital and for patients to have access to diagnostic scans within one hour, 24-hours a day, if they are in a critical condition.

Professor Matt Thompson, Professor of vascular surgery at St George’s Healthcare NHS Trust and Clinical Director for the review, said: “This is not about money or understaffing – we believe there are enough consultants working within the NHS in London, but current working practices leave some hospitals with insufficient consultant cover, particularly at weekends.  One answer may be to bring consultants together in the right places – like centralised services in London for heart attacks and stroke which is already saving hundreds of lives every year in London.  However, it will be up to clinicians and commissioning groups to decide in discussion with patient groups how services should be improved.

“Carrying on as we are is not an option; patients deserve better than to hope the right consultant is available if they are admitted on a weekend.  We have to make the NHS in London work better as a system for patients, and ultimately save lives.”

NHS commissioners, local doctors, nurses and other healthcare professionals are now coming together to consider how to improve services and meet these standards.  This will also involve further discussions with patient groups across London.

Emerging evidence in the coming weeks is also expected that show that centralised Hyper Acute Stroke services in London has saved more than 200 lives since opening in 2010, when services were consolidated in fewer hospital units to make sure healthcare staff with the right skills and equipment were available to treat stroke patients 24 hours a day.

Stroke services in London are now rated as amongst the best in the country, according to the Royal College of Physicians.  This has resulted in more patients recovering quicker from strokes, spending on average 5 days less in hospital, and more stroke patients (14 per cent) receiving clot-busting thrombolyisis to quickly restore blood-flow to the brain.  New evidence is also expected to show that the gap between weekend and weekday mortality rates in stroke patients is reducing and expected to reduce further in the future.

Notes to editors

  • In December 2010, NHS London and London Health Programmes began an extensive review of adult acute general medicine and emergency general surgery services across the capital.  This focused on the care patients receive after admission to an acute medical or surgical unit.  The review did not focus on services within accident and emergency departments themselves.
  • This review focused on adult acute medicine and general services – ie the care adult patients receive on a general ward after being admitted for emergency treatment.  The review therefore did not include patients treated in London’s four major trauma centres (St George’s Hospital, King’s College Hospital, the Royal London Hospital and St Mary’s Hospital).
  • The review involved GPs, hospital doctors, surgeons, nurses and therapists, as well as patients groups, to make sure that their views, experiences and suggestions were heard.  The findings from this review are expected to be published on Wednesday 21st September.  This has been used to design clinically-led commissioning standards that will ensure the delivery of safe and sustainable acute hospital care consistently, weekdays and weekends.
  • Differences in mortality rates for medical and emergency surgery patients admitted on weekdays compared to weekends is not a London-specific issue.  However, London is ahead of the rest of the country in looking at what could be done about it.  Recent reports by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) and the Royal Colleges have shown that across the country, patients do not always get the same quality of care in hospital at weekends as they do during the week.  These reviews have found common themes, including the need for greater involvement by senior consultants to agree the best care for their patients early on.
  • Over half a million patients are admitted to a London hospital on an emergency basis every year.  These are patients who are often the most seriously ill.  They are often elderly and those with multiple or complex medical illnesses, such as diabetes and respiratory disease.

For more information, please contact the NHS London Communications Team on 0207 932 3911 or email media@london.nhs.uk.  Outside of office hours (08:30 to 18:00, Monday to Friday), please call 0844 8222888 and ask for pager LON01.

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