NHS reforms

07.02.17

RCEM: STP threat to A&E departments overstated, but still alarming

The Royal College of Emergency Medicine (RCEM) has criticised STPs’ consideration of reconfiguring A&E departments as options for long-term change, calling the approach “alarming”.

A&E doctors said details on how departments will be configured are “short on the ground”, warning that STPs are ambiguous about how they will do this without downgrading the departments or closing them entirely

The RCEM said such closures would be “disastrous” if they were to come to pass, but poured cold water on the idea that they will actually occur in most cases.

Its president, Dr Taj Hassan, said: “There is a need for change within the NHS, but we must guard against further closures without well thought out measures being put in place to cope with the fallout.

“If it were to come to pass that one in six emergency departments are downgraded, the effects would be disastrous.”

The RCEM’s comments emerged following reports that up to one in six A&E departments risk being closed or downgraded by 2020 under STP proposals, with 33 A&E departments allegedly being considered for closure or replacement with minor injuries units.

The royal college called the threat to A&E departments “overstated”. It accepted that numerous departments are being considered for change, but stressed that the number is likely to be much lower – closer to five departments.

However, the college reiterated that any consideration of closure or downgrading of A&E departments is concerning, calling the measures a “misguided attempt to align demand with resources, rather than the other way around”.

“Closure of any emergency department will naturally require more beds to be found elsewhere – patients do not just disappear when an option for care is removed,” Dr Hassan said.

We need more beds, not fewer, yet seem to be on a downward trend, which will only be detrimental to the health and safety of patients.”

These claims emerge at a time when hospitals are recovering from severe pressures after almost half of England’s 152 NHS trusts declared a major alert over a lack of capacity in January and a higher number of patients were diverted to other hospitals in December than at any other time over the last four years. An investigation conducted this week also revealed that a whopping 90% of trusts in England surpassed the acceptable rate of bed occupancy over the winter period.

But an NHS England spokesperson said: “The number of people seeking urgent care is on the rise so overall we expect the range of services available to them to expand over coming years.

“Within that overall expansion, it may be possible to improve care and save lives with some concentration of specialist urgent services.”

While criticising the proposed closures, the RCEM welcomed many STP proposals to co-locate services around their remaining A&E departments, arguing that 20% of patients could be better treated away from A&E.

Dr Hassan said that overall, the ambitions of STPs are admirable in looking to improve the healthcare system, but the RCEM believes that they are “unworkable” in their present form.

“We would urge STP leaders to be more robust and forthcoming with details as to how they hope to achieve change,” he added. “Obscuring facts with impenetrable language helps no one, especially our patients.”

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