The case for major reform of emergency treatment in the NHS and the creation
of super A&E departments to treat heart attack and stroke patients has
been set out in two reports by leading clinicians published today.
Tony Blair, speaking at an NHS Confederation conference in London, used the
reports as an example of the need for NHS reforms and to say that accident
and emergency departments must change in order to save more lives and give
patients better care.
The reports, written by Sir George Alberti, National Clinical Director for
Emergency Care, and Professor Roger Boyle, National Clinical Director for
Heart Disease and Stroke, both argue that patients would be better treated
at specialised heart and stroke units rather than a patient's local A&E
department, even if it meant a longer journey.
Professor Boyle said that he expects to see 500 fewer deaths, 100 fewer
recurrent heart attacks and 250 fewer serious complications like strokes,
every year because patients will get swifter and more specialised treatment
if the reforms are brought in.
In his report, he argues that paramedics would be able to assess a patient's
condition and decide which hospital can give them the best treatment for
their condition.
He dismissed claims by some campaigners that the reforms were being introduced
to help save the cash-strapped NHS money.
Professor Boyle said: "By giving life-saving drugs to heart attack
victims on their doorstep and using clinical judgements to by-pass A&E
to deliver heart attack and stroke patients directly to specialists, we are
acting only in the best interest of the patient. This is not driven by
saving money but by the aim of saving lives."
Outlining the details of his report, Sir George said; "Every service
cannot be offered by every A&E department - it never has been, and never
can be - so it makes sense to create networks of care with regional
specialist centres to give the best possible treatment to the sickest people."
The two reports have been published at the same time as a separate report by
the Institute for Public Policy Research (IPPR) that argues that campaigns
to save services in district hospitals could lead to 1,000 unnecessary
deaths each year.
It says that complex treatments are better delivered by highly-trained staff
at specialist centres, rather than spread more thinly around local
facilities.
Richard Brooks, IPPR Associate Director, said: "Many people are
understandably worried about local services moving away from their local
district general hospitals. In particular, residents are concerned about
access to care if they or a family member has a heart attack or a serious
accident.
"But if heart attack and serious injury victims were taken past their
local hospitals to a specialist centre, they would be significantly more
likely to survive."
Today's initiatives come as a leaked memo discloses the Government's anxieties
about winning the arguments for NHS reforms. The minute of a meeting between
Patricia Hewitt, the Health Secretary, and other ministers, was published in
the Guardian today.
"Too often the debate on public service reforms seemed to pitch the
government against frontline staff", the paper quoted the minute, which
was marked restricted.
The Prime Minister said today that the reports by Sir George and Professor
Boyle "offer a compelling and vivid account of the changes that are
taking place in modern health care." He told his audience of primary
care bosses that life-threatening emergencies needed specialist treatment.
Mr Blair said: "If you have a rupture of a major blood vessel you need an
experienced vascular surgeon with access to 24 hour laboratory services and
radiology. The right care for strokes now is to have a CT brain scan within
3 hours, followed by aggressive rehabilitation with thrombolysis in
appropriate cases.
"That level of expertise can't be offered everywhere. That is why it
makes sense, alongside local provision, to create specialist centres of
excellence, which have 24-hour consultant cover and access to
state-of-the-art diagnostic equipment," he said.
However, health campaigners argued that instead of improving services, the
reforms would put more lives at risk because patients would have to travel
further for treatment.
Karen Jennings, head of health at the union Unison, said: "The climate of
debt in the NHS puts the development of new policy under suspicion. We are
extremely concerned that these policies may be being driven by deficits, not
what is best for patient care.
"The key to developing new policy in the NHS must be asking the experts -
the staff who work in it - and today's announcements have been made without
any prior consultation.
"If we move towards more specialist units we still need to ensure that
patients have access to really good local A&E departments."
Geoff Martin, of campaign group Health Emergency, said: "Claiming that
closing local A&E departments, trauma units and intensive care
facilities will improve services turns all logic on its head.
"People are fighting these closures in their tens of thousands up and
down the country because they know that closing local services and
increasing journey times puts lives at risk."
