Two-tier plan to solve AE service crisis launched

Guardian News and Media/London

Plans to establish a two-tier accident and emergency service, with specialist expertise in areas such as stroke and trauma concentrated in fewer hospitals, were launched yesterday by NHS England’s medical director, who said it was an illusion to suppose all hospitals were as good as each other.

Sir Bruce Keogh said it was absolutely necessary to rethink under-pressure AE services because too many people turn up there who do not need emergency care.

While 40% leave without any treatment, frail and elderly people end up waiting for hours and sometimes could have been better cared for at home.

The Keogh blueprint for remodelled AE also attempts to sidestep the fundamental political problem inherent in any NHS reorganisation: communities and their MPs take to the streets at any mention of a hospital closure.

Under the two-tier plan, none of the current 140 AE departments in England would close.

But the proposals will still be controversial because some AEs will be seen to be downgraded. About 40 to 70 will become “major emergency centres”, where the seriously sick and damaged are taken by ambulance for hi-tech treatment for heart attacks, stroke and trauma, bypassing other closer hospitals on the way.

The 70 to 100 remaining AEs will become ordinary emergency centres, which will cope with problems requiring less specialised care.

In the House of Commons on Tuesday, Andy Burnham, the shadow health secretary, accused Jeremy Hunt of “running scared” for personally failing to present his proposals for solving the AE crisis to parliament.

Burnham demanded that the health secretary stop the closure of NHS walk-in centres, saying services such as these were the best way to ease the pressure on AE departments.

Hunt said the timing of Keogh’s report was a matter for NHS England, rather than himself. He told MPs the report would not shy away from difficult decisions over AE units as patients are encouraged to seek treatment closer to home.

It would, Hunt said, “provide clarity about the long-term future of AE departments, which has been a difficult issue for this government and for the last government. What people want is stability and what they want to know is, is there a government that is prepared to face up to the difficult decisions?”

Keogh wants the public to wean themselves off their attachment to their local AE.

“We now find ourselves in a place where, unwittingly, patients have gained false assurance that all AEs are equally effective. This is simply not the case,” said Keogh.

The report adds that the likelihood of recovering from a particular illness or injury “varies considerably between hospitals”.

Advances in science have led to the concentration of stroke services, for instance, in just eight of the 32 London hospitals.