Care Pathways


Transforming the way we treat trauma

In this article, Bevan Exemplar and trauma surgeon Oliver Blocker explains why the NHS needs to change to survive in the way it treats and admits trauma patients. He discusses how new models of care are vital to meet the needs of patients with injuries in an overstretched hospital service.

Best for patients?

Right now, in many UK cities such as my own in Cardiff, if you have an injury that requires treatment in hospital – such as a serious cut or a broken bone in your hand that requires surgery – then you are about to have what is known as a ‘patient experience.’  

That experience starts with a long wait in a windowless corridor. There is a TV blaring and you might be expected to spend at least one night sitting in a straight back chair. You will receive the correct initial treatment while you wait, but patients with major trauma injuries or frail elderly patients will be placed into a hospital bed before you. You will not be offered the choice of going home to sleep in your own bed while you wait.

What is often best for patients is to return to have their operation at an arranged time and go home the same day, where they can be much more comfortable. But is the system equipped to give them that option?

Ambulatory care is vital

‘Walking wounded’ patients are no longer a priority for hospital beds. During my orthopaedic training in South Wales, I have seen the pressures on beds gradually increase and our ability to provide a high level of care to our local communities decrease in equal measure. I want to change this and emulate colleagues in medicine who have shifted the models of care in hospitals for walk-in patients.

The revolution is here: the old model of how we admit patients to stay in hospital beds is moving to treating the majority of patients during the day, enabling them to go home and sleep in their own beds.

Joined-up approaches are vital to bring about the radical change we need. Initiatives such as Get It Right First Time (GIRFT), which is helping surgical departments to streamline and standardise their practice; and the Ambulatory Emergency Care Network are making real headway, and already leading to improved outcomes for patients. Patients are involved in the design of these services from the start to ensure these services are appropriate for their community.

The bottom line should be: patients should be treated quickly and efficiently with as short a stay in a hospital as possible.  

Challenging assumptions, changing cultures

We cannot continue the way we have done, and in the face of an increasing frail and elderly population, the NHS must change to survive. Hospital beds are an expensive resource and should be used to treat the most severely injured and older patients who are at the biggest risk if they do not have their complex needs met.

We have innovative ideas to make this happen, which are based on common sense and future planning, not knee-jerk reactions to the constant cycles of NHS pressure and demand.

However, change takes courage from individuals and leaders, and the right support from national initiatives and networks. Organisations like the Bevan Commission in Wales are helping clinical leaders to change practice, as well as NHS culture, to ensure these changes continue to work in future.

Too many health and care professionals I know feel like they are banging their heads against a brick wall as individuals. This does not work. It is time to bring in the architects and the builders to break down these walls, change environments, and build new pathways for patient care.

Having the backing of independent organisations and networks, such as the Bevan Commission, GIRFT, and the AEC Network, can enable innovative projects to be embedded locally in NHS organisations and scale-up nationally.

Old models and assumptions are resilient and often resistant to change. Energy and enthusiasm of staff for transformational change is our biggest asset: let’s use it. We need to think bigger, beyond established hospital spaces and incremental improvements to services. Our focus should be on delivering the care that patients need, with a more efficient use of our limited health resources.


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