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Westminster Hall

Wednesday 11 June 2008

[Dr. William McCrea in the Chair]

Specialist Trauma Response Teams

Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Roy.]

9.30 am

Mr. Mark Oaten (Winchester) (LD): Even after 11 years, one of the joys of this job is that, every now and then, I come across an issue about which I know nothing. Somebody comes into my surgery, gives me a briefing and I go away thinking, “That’s extraordinary. I had no idea that was going on.” Specialist care for seriously injured people is such a subject.

A few months ago, a couple of my constituents—Phil Hyde and Ewan McMorris—briefed me about the work that they did. They said that the subject that they wanted to discuss was pre-hospital care, and I assumed that they would talk about rehabilitation, drugs, therapy or something that would prevent people from going into hospital. However, as the conversation developed, it became clear that they are providing an enormous specialist service, particularly in Hampshire. This morning, I shall go through some of the facts and figures about the service that they provide and consider how the Government can do more to support such work.

In essence, the role of those people is best described as taking the skills of an accident and emergency department out to serious accidents and injuries—most typically, a road traffic incident. The service they provide is different from that of the ambulance service, paramedics, and first responders, who are now quite commonplace and whom many of us will have in our constituencies. The philosophy behind immediate care is the prevention of the deterioration of a patient in those first critical minutes between the time of an accident and before they are taken to the A and E department.

I had assumed that such a critical service would be part of the NHS, but it is not. I was surprised to discover that the service is provided by volunteers, charities and a couple of organisations that work closely in the field. The British Association for Immediate Care—BASICS—and the Mid-Anglia General Practitioner Accident Service, which is an emergency medical charity, are the major players in the service. My amazement at the service they provide, coupled with my astonishment that it was not centrally funded, meant that I decided to probe the matter and do a bit more work on the subject.

I am delighted that my hon. Friend the Member for Romsey (Sandra Gidley) is here because I know that she has met the individuals concerned and has taken up some of the issues on their behalf. In Hampshire, we are lucky to have the service that they provide. On average, they attend an incident between two and eight times a day. In the Hampshire area, there were 1,200 requests a year for basic doctors and, through the work the charity does and the volunteers that it has, it is able to attend 750 of those calls. There is a big demand, but the
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worrying statistic is that although it is good that we have volunteers, they are not able to meet all the calls made on their watch.

The work involved often relates to traffic incidents, and we know that, on average, some 3,460 traffic fatalities take place each year. We also know that trauma is one of the big causes of death in this country. The latest figures suggest that trauma remains the fourth leading cause of death in western countries, including this country. Clearly, much work needs to be done to try to reduce the number of deaths. For each trauma death that takes place there are two survivors, who often end up with a serious and permanent disability. Anything that we can do to reduce the disabilities and injuries from which such people suffer will have a big impact on their lives.

The model that we have in this country differs from the rest of Europe. For example, Germany takes a different approach to trauma care. There is a nationwide network of helicopters and road vehicles that can, in 95 per cent. of cases, get a skilled doctor to the scene of an incident within 15 minutes. We even trail behind America in relation to trauma care. The UK mortality rate for severely injured trauma patients who are alive when they reach hospital is a staggering 40 per cent. higher than that of the US.

We know that the level of trauma-related deaths is high in this country, and that other European countries and America are able to tackle the problem better. We also know that, despite the various forms of support provided by ambulances, paramedics and first responders, there is still a desperate need to have skilled consultants and doctors who are able to get out to the incident. In Hampshire, although demand for the service is high, it is funded by charities and good will.

Why is it so important to have specialists as part of the service, and what do they do that is different from first responders and paramedics? First responders would be the first to acknowledge that they are not fully medically trained and can in no way replicate the work of a specialist doctor in A and E. It is also the case that, despite the wonderful work that paramedics do, their degree course lasts just three years. Let us compare that with the training required to be a consultant. Typically, a consultant in A and E would get five to six years at medical school and then a structured 12-year training programme before becoming a consultant. That is the level of skill and knowledge required to treat the most severe incidents of trauma.

The particular specialist skill needed relates to the airways and breathing of patients who have had severe head injuries. Paramedics are not trained to clear the airway or use the necessary drugs and anaesthetics in the treatment of those injuries. In many cases, paramedics are legally prevented from doing so because they are unable to administer the drugs. All the evidence that I have seen suggests that the critical area that an individual needs to have treated at an incident is around the airway, and that anaesthetics and drugs need to be issued. None of those who currently attend incidents are able to treat that specialist injury. However, the specialist consultants from A and E departments can do so, and we are trying to ensure that more of them can carry out that particular work, often at the roadside.

A fair bit of work and research has been done on the subject. The most recent report was in 2007 when the National Confidential Enquiry into Patient Outcome
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and Death produced a report entitled, “Trauma: Who Cares?” The report takes a general look at how we handle a situation when there is an accident leading to trauma, and considers what happens in the first few moments after an incident. It states:

The report highlights the particular specialist skills needed at the scene of an accident. In the study, NCEPOD produced an analysis stating that 60 per cent. of patients whom it looked at received a standard of care that was less than good practice. It also states:

Again, the critical issue is seniority and people having the skills to tackle breathing and airway problems.

It is not just NCEPOD that has looked at the issue; the Royal College of Surgeons has also raised concerns in a number of studies. Initially, in 2000, the college called for defined trauma systems comprised of major trauma centres to be established in each region. It describes—in its words—

to tackle the issue. It revisited the subject in 2006 and reported little progress or improvement. Its analysis is that the likelihood of dying from injuries has remained static since 1994 despite great improvements in trauma care, training and education. There are not many areas of the health service in which things have remained static since 1994, certainly under the Labour Government—I welcome some of their investments. With many of the indicators, one can see that the advancement of knowledge has been matched by improved outcomes, but this area has remained static since 1994.

Last night, the RCS e-mailed me with a further update on the issue, in which it raised more concerns. It welcomes the fact that volunteers and charities are putting provisions in place throughout the country, but says that coverage is patchy. It describes a postcode lottery and says that there is great inequality in access to and provision of pre-hospital critical care. As a consequence, there are preventable pre-hospital and early-hospital deaths that could have been averted had there been access to appropriate services.

It is troubling that the RCS is saying that we could save lives if we had that kind of system in place across the country. In its note, it estimated that a national system of 24-hour access to specialist physicians who could go out to incidents would probably require an additional 200 specialist practitioners, who would need to be funded. I do not have more accurate figures than that estimate, but if those are the kind of figures involved and if it would have a dramatic impact by cutting the number of deaths, as the RCS says and as other evidence suggests, it would be a small price to pay.

Air ambulances are critical to the ability to save lives after a traumatic incident; however, there are contradictions. I understand that, in London, daytime provision of the
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air ambulance is centrally funded, but that the evening service switches to charitable funding. There was a debate on air ambulances in Westminster Hall in February for which the RCS did a lot of work. It said how important the role of air ambulances is, but it was extremely concerned that it is left to charitable trusts and individual primary care trusts to fund them. The RCS argues strongly that it is excellent value for money to have an air ambulance.

Another issue that the RCS has raised is the provision of helipads close to accident and emergency departments. There are many examples—including one in Southampton, close to the constituency of my hon. Friend the Member for Romsey—of the ridiculous situation in which the air ambulance is able to get to the scene of a trauma quickly, but is then unable to land near the hospital and has to land a six or seven-minute ambulance journey away from it, so an ambulance has to go to the air ambulance and bring the patient to the hospital. After the air ambulance has provided such a quality service, having got to the scene quickly, it is enormously frustrating to the professionals involved that an additional journey is needed at the end.

Bob Spink (Castle Point) (UKIP): I am sorry to interrupt the hon. Gentleman’s flow, because he is being extremely eloquent in showing how much he cares about this important issue. I congratulate him on securing the debate. Is he aware that when the new Queen’s hospital opened in east London, with a specialist neurosurgical centre, the local council placed restrictions on the landing of air ambulances delivering patients at certain times of day? That was an unhelpful interpretation of the balance of inconvenience by the various players in that decision.

Mr. Oaten: I was not aware of that, and I find it extraordinary that a local council representing potential patients would take that decision. Certainly, my conversations with the chief executive of Southampton hospital suggest that he would not have that kind of difficulty with Southampton city council. He thinks that the population would strongly welcome hearing the sound of a helicopter and would find it reassuring.

Sandra Gidley (Romsey) (LD): I have written to Mark Hackett, the chief executive of Southampton University Hospitals NHS Trust. He is keen on having a helipad, but pointed out that funding for it is not available and that there would have to be some sort of public appeal to raise money for it. Given that we are talking about something that could save lives, does my hon. Friend think it right that local members of the public should have to dip into their pockets yet again?

Mr. Oaten: I had a similar conversation with Mark Hackett, who told me that the cost, on its figures, would be about £1 million. He hoped that it might be possible to reduce that cost by putting a helipad on top of a building and incorporating that into ongoing rebuilding at the hospital site. I am no engineer or scientist, but one would think that reasonably easy to achieve. It is breathtaking that such a service should have to depend on charity in today’s modern world, particularly as it would cover a region with a radius of about 150 to 200 miles. It would provide a quality service covering
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the Isle of Man and going through to Dorset, which is an enormous area. One would think, therefore, that it would attract public funding.

It is not for me to tell any of the three political parties what would be an eye-catching issue at the next general election—I am not standing at the next election, so I do not mind too much—but I should think that any party that commits to introducing 10 helipads across the country to ensure that individuals can get straight into an accident and emergency department would have a simple, popular message with a particularly low cost. It is extraordinarily odd that we leave the funding of air ambulances and their work to the good will of volunteers and charities. I hope that the Minister will comment on that.

Bob Spink: But will the hon. Gentleman accept that there are four political parties, please?

Mr. Oaten: Four, five, six or seven—anyone is entitled to put forward the policy, but it would be wonderful if the Minister prevented other parties from doing so by announcing something today.

Let me address what is the best way forward with funding. I totally understand that there are demands on Government funding and I am reluctant to say to a Minister, “Come on, cough up,” because so many areas have to be funded. I know from parliamentary questions on this issue that the Minister and his colleagues have said, “Look, fantastic work is being done and we totally recognise that this is providing a real benefit to the health service, but it is for local PCTs to decide whether to fund it.” That is a cop-out, because we know the pressures that local PCTs are under. Is it right to say that we are going to leave it to the lottery of whether a PCT is able to support such work? People throughout the country—certainly my constituents and, I am sure, those of other hon. Members—want the reassurance that they will get the best-quality support if they are involved in a major trauma anywhere in the country, but that is currently left to good will and chance.

I hope that the Government will consider this issue further and do more work on it. I am encouraged by some of the statements that have come from Ministers so far, who have at least acknowledged that there is more work to do. Lord Darzi said:

I could not agree more and I hope that the Minister present agrees with his colleague. With that in mind, I ask him to confirm whether he plans to meet the authors of the NCEPOD report. In a written answer in April, he told me that officials were arranging for a further meeting to take place, so I hope that progress has been made with people’s diaries; indeed, the meeting may have taken place.

According to a written answer last year from one of the Minister’s colleagues, who has moved on to the Home Office, the Government acknowledged the work
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of the RCS in this area and were hoping to do more work and have meetings with it. It would be helpful to know whether that work has been done and whether the Government have made an assessment of the RCS reports on trauma.

I was amazed to discover that the whole area of specialist trauma response did not exist as part of the NHS. Having met the surgeons involved, I am convinced that, despite the good work of paramedics, the ambulance service and first responders, there is a very big gap—the ability of high-quality experts with high levels of training to reach the scene of an incident quickly and provide the drugs, skills and airway support that definitely could, based on studies done so far, save lives. Linked to that is the question of a decent, funded air ambulance service. We need to put the two elements together. If the Government were prepared to move on this and to put some funding in—not necessarily fund the whole project, but put in some match funding—we could make a significant difference to the number of people who are dying unnecessarily in traffic accidents and as a result of other serious injuries.

9.51 am

Sir George Young (North-West Hampshire) (Con): I just want to add a footnote to the excellent speech made by the hon. Member for Winchester (Mr. Oaten)—my parliamentary neighbour. As you may have seen, Dr. McCrea, a high percentage of Hampshire MPs are present.

I pay tribute to the work of Dr. Phil Hyde and the team in Hampshire for raising the profile of this issue as well as providing the help that the hon. Gentleman described. Like him, I was not aware of the service until my constituent, Dr. Louisa Chan, who lives in Whitchurch, wrote to me. She is one of 19 volunteer doctors and one consultant nurse in the county who act as volunteers working for BASICS—in her case, after doing 56 hours of full-time work for the NHS. She uses her own car with a blue light in responding to call-outs. As the hon. Gentleman said, at the moment, the team can respond to about half the number of call-outs. Of course, they are not called out every time that an ambulance is summoned; they are called out only to the more serious emergencies where their skills could make the difference between life and death. I pay tribute to those volunteers. They were very active following the train crash at Ufton Nervet a few years ago; they were on the scene very quickly.

I want to put this issue in a slightly broader context. The hon. Gentleman touched on the fact that one could argue that this is not the only service that ought to be mainstream NHS but is slightly at arm’s length from it. I suppose that the best example is the hospice movement, which one could argue ought to be mainstream NHS. It started off in this country totally independent, run by voluntary organisations, but it is now moving more towards the mainstream NHS; the hospice movement is receiving more support. In Hampshire, we have fantastic hospices: Naomi House, in the hon. Gentleman’s constituency, and the Countess of Brecknock hospice and St. Michael’s hospice in my own. That is an example of a service that started outside the NHS but is gradually being absorbed into the bloodstream, if I can put it in that way.


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