01.12.14
Plans to rearrange A&E services ‘put on hold amid fear of political backlash’
NHS England is denying that it has put on hold plans to reconfigure A&E units across England into two tiers because of warnings that it could create a public backlash.
The plan, which would see 40 to 70 A&E departments become “major emergency centres” to care for the most critically ill patients, was outlined last November by NHS England medical director, Sir Bruce Keogh. He said the move was needed to save lives and it was an “illusion that all A&Es are equally able to deal with anything that comes through their doors”. No A&E departments would be officially downgraded or closed, but the practical effects of such a centralisation would still be politically contentious.
Insiders told the Guardian that the plans have been put on hold as they would represent “political suicide” this close to a general election. One source told the paper: “All his talk about reconfiguring emergency departments, about splitting them into supercentres and other ones, has died a death.”
But Professor Keith Willett, NHS England’s director for acute episodes of care, has said: “There is absolutely no question of slowing down on the review. It is a central part of the NHS Five Year Forward View and the pace is about to accelerate. Sorting out the urgent care system is one of the most important priorities for the public and for the NHS.
“The heavy lifting starts in 2015-16, which will include the formation of urgent care networks to include all hospitals with A&E departments across England. We expect networks to identify the 40-70 emergency centres which have specialist services.”
When proposing the plans, Sir Bruce argued advances in medical science meant that a minority of hospitals needed to have the specialist doctors and equipment required to maximise the chance of saving patients facing life-threatening illnesses.
He said: “There will be between 40 and 70 major emergency centres but they will be connected as part of a network to smaller emergency centres who will still be receiving the majority of ambulances. By passing patients with acute conditions on to the specialist centres, we can decongest smaller A&E units so they have more capacity.”
However this was disputed by the College of Emergency Medicine, which represents A&E doctors. The organisation said that the massive centralisation of services was never justified clinically.
Dr Cliff Mann, its president, said: “In my view, the urgent and emergency care review started from an erroneous premise that the system that has been applied with some success to the treatment of heart attack, stroke and major trauma could be applied to many more conditions and hence ‘regionalisation’ of major centres was a likely outcome.
“It has become evident from evidence submitted to the review that fewer than 4% of A&E attendances might derive any benefit from such a reconfiguration. Importantly, such a system works well only for severe conditions requiring very specialist services where the diagnosis can be made before the patient even reaches hospital. It is easy to spot when someone has been hit by a bus, fairly easy to spot the classic signs of a stroke and all ambulances carry machines capable of diagnosing an acute heart attack.”
Despite this the health secretary backed Sir Bruce and said his vision would be implemented. Reorganising A&E services which the public value dearly would show the coalition was “a government that is prepared to face up to the difficult decisions”, Jeremy Hunt said.
The Guardian reported that the planned changes are not mentioned in a 13-page document setting out the most recent update on the transformation of urgent and emergency care services, which NHS England circulated in August. It says that the review’s report last November “recognised the appetite for change but emphasised that there will be no risky ‘big bangs’”.
The paper said that insiders involved in the review told them NHS England has been warned that introducing what amounts to a two-tier A&E system will prompt opposition, including from MPs and councillors, in areas where the local hospital could be seen as being downgraded if it did not become one of the 40-70 major emergency centres.
Hospital chiefs were also opposed to the move, citing concerns that it could lead to a loss of vital income and may lead to many smaller A&Es eventually having to close.
NHE asked the Department of Health for comment but they had not responded by the time of publication.
(Image: Sir Bruce Keogh c. Joe Giddens - PA Archive)
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