NHS England publishes new data on the progress of hospitals in acute emergency and maternity care across London

  • More London hospitals are delivering high quality acute emergency care across all seven days of the week
  • Eight in 10 of the capital’s hospitals deliver 1:1 midwife care for all women in established labour

NHS England London has today published new data on the progress of hospitals in meeting standards for acute emergency and maternity services across London and it shows more are delivering high quality acute emergency care for patients across all seven days of the week.

London has pioneered this approach to improving the quality and safety of emergency care [1]. Acute hospitals across the capital have been working towards meeting the 26 standards for acute medicine and emergency general surgery since April 2012. Latest data from 29 acute hospitals across the capital[2] shows they are making progress on meeting these standards compared to data published last year.

The latest self-assessments are being released by NHS England London today, on behalf of London’s Clinical Commissioning Groups, to highlight areas of progress, show where further work is needed and demonstrate its commitment to ensuring all patients receive safe and high quality care, whenever they go to hospital.

Following the development of standards for acute medicine and emergency general surgery further standards were developed for the broader acute patient pathway – to include emergency departments, critical care and a common form of hip fracture known as fractured neck of femur – and paediatric emergency services along with maternity services, to ensure these services were also safe and high quality, seven days a week.  For the first time, self-assessments are being published on this wider range of standards.

Analysis of the latest data for adult acute medicine shows patients are being seen and reviewed more quickly by consultants when admitted as an emergency and can access diagnostic tests more rapidly. Every standard for acute emergency services is being met by at least one hospital in London.  However, there is still a significant way to go as no one hospital currently meets all the standards set.

The new self-assessments for maternity services for 2013 show 81 per cent of the capital’s hospitals deliver 1:1 midwife care for all women in established labour across all birth settings. However, no one hospital is currently providing consultant obstetrician cover on the labour ward 24/7.

The London Quality Standards were developed by clinicians and patients[3] following concerns about how services are delivered over the weekend, with lack of access to senior medical staff and limited access to diagnostics cited as major factors in poor outcomes for patients.

Data showed that patients admitted for emergency treatment at the weekend have a 10 per cent higher risk of dying compared to those admitted on a weekday. If the mortality rate in London for patients admitted at the weekend was the same rate for patients admitted during weekdays, there could be a minimum of 500 fewer deaths a year[4}.

A 2012 study also found London’s maternal death rate was twice the rate of the rest of the UK and a separate review into maternal deaths highlighted avoidable factors like inadequate supervision and delays in referrals.

The latest self-assessments show:

  • 55 per cent (16 out of 29 hospitals) of London hospitals  now deliver consultant review for adult acute medicine within 12 hours[5]  compared to 35 per cent in 2012
  • 45 per cent (13/29) of hospitals are meeting standards for timely access to diagnostic tests 24/7  for adult acute medicine compared to 21 per cent in 2012
  • 72 per cent (21/29) of hospitals now provide extended day working by consultants for adult acute medicine compared to 28 per cent in 2012
  • 23 per cent (6/26) of hospitals now provide multi-disciplinary team assessment within 12 hours for emergency surgery compared to zero per cent in 2012
  • 81 per cent (22/27) of the capital’s maternity services deliver 1:1 midwife care for all women in established labour
  • 93 per cent (27/29) have specialty trained doctors present in the Emergency Department 24/7
  • 90 per cent (26/29) ensure that all ‘high risk’ patients are seen within an hour by a consultant when on an intensive care ward.
  • All paediatric inpatient wards have a minimum of two paediatric trained nurses on duty at all times.
  • 52 per cent (13/25) of hospitals undertake surgery for fractured neck of femur patients within 24 hours.

The London Quality Standards were all endorsed by the London Clinical Senate[5] and the London Clinical Commissioning Council.

Dr Andy Mitchell, Medical Director, NHS England London Region, said: “We want patients to receive consistently high quality emergency care seven days a week, but we know that is not always happening at the moment. That is why London’s clinicians are leading the way by developing standards to eradicate the ‘weekend effect’ which could be costing 500 lives a year.

“We are pleased that acute hospitals across London have taken part in the latest self-assessment and have been working hard to meet the standards, resulting in good progress over the last year.

“However, it is clear there is still some way to go and we hope that making these self-assessments publicly available, patients can make an informed choice about their care, which will, in turn, drive up standards even further. We want all patients to receive safe and high quality care, whenever and wherever they go to hospital.

“For all hospitals to meet all the standards we will need to change the way some services are provided at a local and at a network level.  London’s CCGs are working on five year plans which will describe how every hospital will deliver all the standards. ”

Dr Howard Freeman, Chair of the London Commissioning Council said:  “Hospitals across the capital are stepping up to the challenge set by the standards and are moving in the right direction. As commissioners of services, we want to see hospitals continue to make progress and further improve the quality of care at every hospital in London.”

Dr Ian Abbs, Medical Director at Guy’s and St Thomas’ NHS Foundation Trust, said: “Providing high quality acute emergency care across all seven days of the week is essential to improving patient outcomes and that is why we are committed to meeting these standards.

“They are challenging and we still have improvements to make but in the past year we have made great strides, particularly around the review of patients within twelve hours specifically in emergency general surgery, and increased consultant presence and involvement in all emergency general surgery.”

Professor Jacqueline Dunkley-Bent, Director of Midwifery at Imperial College Healthcare NHS Trust, said:  “With so many babies born every day across London, it is essential that our maternity services are safe and of high quality.

“Completing the self-assessments on maternity standards provides a clear marker for each hospital about where further improvements could and should be made and will help to further drive up standards across London.”