Emergency department closures in one-third of STPs ‘will put lives at risk’

Sustainability and transformation plans (STPs) could have a “catastrophic” impact on emergency care, the Royal College of Emergency Medicine (RCEM) has warned after a survey revealed that almost a third of CCG leaders are considering closing emergency departments.

The survey, of 99 CCG chairs and accountable officers, found that 31% said their STPs were likely to lead to the closing or downgrading of A&Es in the next 12-18 months.

Almost half said they expected a reduction in beds, while 23% expected a reduction in full-time acute staff and 21% expected one or more hospitals would stop consultant-led maternity.

Dr Tajek Hassan, president of the RCEM, said: “These plans that are emerging via different routes, if true, are potentially catastrophic and will put lives at risk. A number of systems around the country are already at breaking point and this will be the straw that breaks the camel’s back for them. Others that previously were just coping will become unstable and unsafe.

“The multitude of problems facing emergency departments – including the worst four-hour performance for a decade, staffing shortages and overcrowding – will not be solved by closing units and removing beds. Patients will not simply disappear.

“Nor is there any consistent successful track record of movement of such work into the community – in fact quite the reverse has occurred with a steady rise of ED attendances in most systems.

“On this basis STPs will certainly not create sustainability and any transformation that results will not be safe, effective or patient centred.”

There were also positive results in the survey, with almost 80% of CCG leaders saying their STP would lead to stronger attempts to discourage unhealthy behaviour and 59% claiming it would lead to more GP services opening at evenings and weekends.

But Janet Davies, chief executive of the Royal College of Nursing, warned: “With NHS finances in such a perilous state, there is a real risk that cuts to staffing and services will be made as a short-term budget fix with little regard for the longer-term consequences for patients.

“Staff, patients and their loved ones can already see that hospitals are working at full stretch, and it is very difficult to see how beds can be cut without having a real impact on care.” 

Cathy Warwick, chief executive of the Royal College of Midwives, argued the proposals “look alarmingly like cost-savings disguised as service improvements”.

Katherine Murphy, chief executive of the Patients Association, added: “Cuts will only put even greater stress on services already buckling under the pressure of continual cuts, poor workforce planning and lack of proper long term investment.”

So far, three footprints – Birmingham and Solihull, North West London and South West London – have published their STPs.

South West London’s STP said it would involve closing one of the area’s five acute hospitals, while North West London noted that it is considering “challenging” service consolidations.

Yesterday, members of the Health Select Committee also wrote to chancellor Philip Hammond warning that the STPs may not be achieved unless the government provides the NHS with more capital funding.

A Department of Health spokesperson said: “We know the NHS is under pressure, and to ensure the best standards of care in the future we need an updated system which even better prioritises GP access, cancer care and mental health treatment.

“The NHS is using sustainability and transformation plans to help deliver this change. No decisions have been made and none will occur without local consultation."

(Image c. Andrew Matthews from PA Archive)

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