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Do NHS targets result in poor treatment?

29 September 2011

Martin Beckford (Health Correspondent for the Daily Telegraph) reported that, according to the Royal College of Surgeons, up to half of the very oldest patients undergoing some types of urgent operations die each year because of poor treatment. Elderly people needing emergency operations are being ignored “to the point of neglect” because hospitals care more about meeting waiting time targets. The report warns that patients are “languishing” in general wards rather than in critical care, are being seen by junior staff rather than consultants and are suffering delays in their treatment. Many also develop dangerous infections.

Part of the reason why emergency surgery patients receive such poor care is that NHS trusts put more effort into meeting Government goals to carry out planned treatment within 18 weeks of a GP referral, it is claimed. Norman Williams, President of the Royal College of Surgeons, said: “The focus on reducing waiting times for elective procedures has resulted in a large group, of mostly elderly patients, becoming seriously under prioritised to the point of neglect in the some NHS hospitals.”

Iain Anderson, Consultant General Surgeon at Salford Royal NHS Foundation Trust, said: “Every single emergency patient who comes through the door of an NHS hospital should have an individual risk assessment, diagnosis, treatment plan and post -operative care plan prioritised according to need.“Instead we have some of the NHS’s sickest patients languishing on inappropriate wards, treated by juniors and with no plan in place to deal promptly with unexpected complications. These tend to be the patients who end up in intensive care units for lengthy periods of time or, sadly too sick to be helped.”

Thursday’s report, on a “forgotten group”, states that 170,000 patients in Britain undergo higher-risk non-cardiac surgery each year.But 100,000 of them (58 per cent) will develop significant complications, resulting in 25,000 deaths (14 per cent).The study says that higher death rates are not uncommon among at-risk groups such as the elderly and those with other diseases, and “can reach 50 per cent in the over-80s” for stomach surgery.

By contrast, death rates have been cut substantially in heart surgery partly because of the work of specialist units and improved reporting of outcomes.The report says that non-cardiac patients receive worse care if they are admitted at weekends or seen at the end of the working day, when fewer senior clinicians are in the operating theatre.Patients endure delays in assessment, decision-making and treatment, while junior staff often fail to call for help. Many are also kept on general wards rather than being admitted to critical care, and those that are admitted after often discharged after only 24 hours.

Sub-standard care leads to complications such as blood poisoning – sepsis – that can cause organ failure and death. But thousands of these deaths would be avoidable if care was better across the country, it is claimed.The report recommends that emergency cases should take priority over planned operations if deemed necessary, and that all patients should have their risk levels assessed before being seen.Those at high risk of death should be treated by a consultant surgeon and consultant anaesthetist, and towards the end of the procedure the patient’s risk level should be assessed again to decide if they need to be taken to critical care.

A national audit should be carried out of the results of unscheduled general surgery so that local variations can be studied and tackled.

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