Lifeblood

HOSPITAL ACQUIRED VENOUS THROMBOEMBOLISM : THE STORY SO FAR

For many years Venous Thromboembolism (VTE) has been known internationally as the silent killer – in England and Wales alone, there are at least 25,000 estimated 60,000 deaths a year from the condition, possibly 60,000, with half a result of hospital admission. Lifeblood has been instrumental in raising the profile of thrombosis with the Government. This section sets out key Government responses to the thrombosis policy debate.

2005

• JULY 2005: the Health Select Committee recognised the scale of the problem, prompting the Government to establish an independent expert working group to make recommendations on developing a national strategy on the prevention and treatment of VTE. 
  

2006

• MAY 2006: In response to John Smith MP request that Tony Blair MP outline the Government measures to prevent VTE, the then Prime Minister made the following statement in the House of Commons:
  
  “There are about 25,000 deaths a year from thromboembolism. It is a serious issue, as he rightly implies, that requires comprehensive action. Following the report last year of the Select Committee on Health, the Department of Health established an independent expert working group, which will report to the chief medical officer. Recommendations will be made by the summer, so within the next few weeks we will be in a position to say what more we can do to try and tackle the problem.”
  
  
• JULY 2006: Expert Working Group present their report and recommendations to CMO
  
  
• JULY 2006: Andy Burnham MP, then Minister of State for Quality & Delivery stated in the House of Commons, that “once the expert group had assessed the current guidance on VTE, the Department would ask that the Healthcare Commission look to seek conformity with this good practice.”
  

2007

• APRIL 2007: the Chief Medical Officer published his response to the expert working group.
  
  Key Recommendations
  
  
  • All medical patients should, as part of a mandatory risk assessment, be considered for thromboprophylaxis (blood clot prevention) measures.
    
    
  • Intermediate risk surgical patients or those with concomitant medical conditions should, as part of a mandatory risk assessment, be considered for graduated compression stockings combined with blood thinning medicines (heparins).
    
    
  • Core standards to be set by the Department of Health for the NHS and independent sector to ensure that there is full compliance with the requirement for risk assessment.
    
    
  • Public and professional understanding of VTE should be improved through better communication of information to patients and the public, accompanied by improved and coordinated programmes of professional education.
    
    
  • Establishment of VTE demonstration centres with an expanded role addressing demonstration of best practice.
    
    
  • Compliance should be monitored by the Healthcare Commission through its assessment and inspection procedures.
    

• APRIL 2007:  the National Institute for Clinical Excellence (NICE) published its guidance on the prevention of VTE in high-risk surgical in-patients making the key recommendation that all patients should be risk-assessed.

• MAY 2007 - CMO commissioned an Implementation Working Group (IWG) to develop national risk assessment tool to assess what needs to be done to ensure that the guidance becomes a reality. The group has been given two years to undertake this but it is expected that the design of the tool will be completed by Spring 2008, leaving it up to the Department of Health to take this forward, including a consultation on the risk assessment tool.
  
  
• NOVEMBER 2007: The All-Party Parliamentary Thrombosis Group published a Research Report into the uptake of these recommendations by all Acute NHS Hospital Trusts in England.
  
  
  • This found nearly all hospitals are now aware of what VTE best practice looks like
    
    
  • But - over two thirds of NHS Trusts admit to not having in place a documented mandatory risk assessment for VTE of every hospital patient on admission, as recommended by the CMO and NICE guidelines.
    
    
  • With this low figure of risk assessment set against the annual rate of VTE deaths, identified conservatively at 25,000 per year by the Health Select Committee, up to 15,000 hospital patients may have died as a result of NHS Trusts’ failure to implement the key recommendations on VTE published seven months previously.
    

2008

• JANUARY 2008: Health Select Committee Report into the work of the National Institute for Clinical Excellence (NICE) recommended, “Elements of clinical guidelines… such as risk assessment of VTE patients should be mandatory.”
  
  
• It still remains unclear how the Healthcare Commission will be tasked with auditing the uptake of the CMO’s recommendations.