all of you who live in urban areas should consider the possible consequences if there were a 2 hour drive to the the nearest hospital--yes if our local A/E were closed then 2 hours for those of us who live in certain areas of North Devon and that is not allowing for traffic problems excerbated by government plans to build houses in this area (each house is expected to generate 2 cars on already crowded rural roads) , This government must not be allowed to destroy the NHS and we must all have access to facilities which we pay for through our taxes.

M Webb, Beaford, Devon

Will the govenment ever learn? I remember going through cut backs in the late 1980's, when I was moved from an A&E unit at a little city hospital called Myrtle Street, those familiar to Liverpool will know that it covered the city centre and gave immediate access for children needing A&E care.It moved to Alder Hey, the other side of town! A& E units are the doors to our hospitals , does this mean we will now develop hospital clinics where you wil go having been sent from GPs and not through direct access gained from expert staff and assessment teams in the A&E units . the first hour of any accident is vital, The Golden Hour! Where will all these people access this type of care from given the govenments new ideas to cut back the units we all use and need?

Caroline Hayden, Denbigh, Denbighshire

A&E departments are not there to cheer people up or win votes. They are there to provide good safe clinical care in emergency situations. If good clinical practice is best served by centralising to allow specialisation, then it is surely a no-brainer – unless “popular” is more important than “appropriate”. Minor injury units, paramedics and care closer to home are clearly important parts of the overall safe mix, but small A&E units were the last century’s solutions – we deserve safer, better solutions in 2007.

Contact, Gloucestershire, UK

Up to half of all hospital accident and emergency departments face cuts or closure under plans to improve patient care...

Is it that I have grasped the wrong end of the statement. Cut or close to improve patient care.

Oxymoron?

Jeremy Bell, Martock, England

Martin of London is spot on. Our local A&E is proposed for closure leaving us with an hour's drive to one of three. Disastrous and potentially fatal for any emergency. We have no walk-in clinics and waiting times are already half a day. Our son was rushed into hospital 14 times last year, I don't think he would be with us if the closure had already happened. Hospitals and pensions - god save us from the party of the people!

John, East Sussex,

Back in the 1990s I was involved in just such a review of how acute services should be distributed in Dorset. Two hospitals each of about 800 beds were 7 miles apart and served a conurbation of close to 500,000 but effectively more because of the numbers of elderly. Both hospitals retained A&E departments but they had different functions. One takes all the trauma cases and all the childhood, ENT and obstetric emergencies. The other takes the ophthalmology and the bulk of the medical emergencies, having state-of-the-art cardiac and stroke services.

This was the right local solution. There is no one-size-fits-all answer. Every solution has to be local. What will work in London won't work in Cornwall or Leicestershire or Surrey.

Prof. Terry Hamblin, Bournemouth,

When will we people stop whining on, health care today as never been any better, but if we want it to improve even further we need to change the way in-which healthcare is delivered. Today’s healthcare is not about buildings, it’s about being treated at home more and more, just stop and think of the conditions we can be treated from home for now that many year ago we would of died from let alone be treated for in our hospitals of yesteryears .
By politicians, local councillors, staff and people continually banging on about keeping local healthcare in appropriate building must stop. This is both costing to you and me in wasting valuable tax payers money, it’s also stopping the NHS from moving forward for the better.
Paul Belgium – Manchester “one patient that knows how important it is for service to change and not be held back)

paul Belguim, Manchester,

Well obviously this will not happen until the day after the next election and by then hopefully we will have a new government. Kick out the bean counters and administrators, save yourselves their salaries and start spending on front line services again. The costs of the adminstrators and bean counters far outweigh any "savings" or "improvements" they may pretend they are responsible for.

phil, London, uk

This is a good idea, as long as the concerns about geograpical coverage and associated distances of travel are addressed.

I want to go to an A&E that is proerly resourced if I have a serious problem. I do not want an ambulance to take me somewhere where it takes time to find they can't cope and then to have to go somwhere else.

The local hospital can heve a minor injuries unit for bumps and sprains.

Savings from the need to run a 24/7 rully resourced A&E with expensive consultants on duty or call can be applied to the bigger, more comprehensive units that would reap economies of scale.

Ian, Crawley, Sussex

Can anyone remember who said, "We have 24 hours to save the NHS.", or is this a figment of my imagination?

David, Surbiton, UK

Our newly re-organised PCT is to close the Minor Injuries Unit (MIU) at our recently rebuilt community hospital to make a saving of £250,000 a year. The MIU, open every day, provides a valuable service to a rural population of about 40,000 and treats 30-35 patients a day. Patients will now be expected to travel for 40+ minutes to the nearest MIU for treatment and inevitably, some will call an ambulance and be taken to A&E in Swindon. Here, treatment will cost a minimum of £70 per patient and if only 10 patients a day ( a conservative estimate) go to A&E, the annual cost to the PCT will exceed the saving made by closing the MIU.

It is difficult to understand the logic behind this decision. But, in common with many other NHS plans, it appears to ride rough-shod over the wishes of the local population who, it should not be forgotten, pay for the service through their taxes and who do have a vote.

Paul Lefever, Marlborough, Wiltshire

An old fuddy-duddy writes; I remember my economics teacher at school explaining economies of scale. He explained how double-decker buses carry more passengers than single-deckers of the same length. He further pointed out that triple-deckers would not fit under bridges and would tend to fall over round corners. In other words, the principle of economies of scale does not go on for ever.

The people who plan health services have lost sight of this.

Dr Michael Crawford, Bingley, UK

I do not agree that the majority of people with minor injuries that require A&E treatment will benefit. Recently I spent nearly 3 hours waiting in such a unit, in excruciating pain, just for an X-ray and a doctor to have a look at the result. It appeared to be a quiet night with just 3 or 4 patients in receipt of care (or the absence of it). I do not call this good patient care. With the closure of smaller units people will have to travel further and wait for longer, especially if they are unlucky and it is a busy night. And busy nights will be more of a standard, as units will serve larger numbers.

K, Warrington, UK

When we moved here, there was an A&E unit at Windsor. This was closed despite local protest and the thousands of tourists coming to Windsor every year.
Our next nearest is Heatherwood at Ascot. The A&E is a 2 aspirin / 2 stitches unit, keeping office hours as far as I can tell. Ashford is now a GP walk in centre despite local protests and being closest to Heathrow. We now have to go to Wexham Park the other side of Slough [too far] St.Peter's Chertsey [too far and no bus] or Frimley [ditto[].
My son-in-law gashed his leg yesterday. A nasty, dirty wound from a cement laden angle grinder disk. He opted for the walk in centre at Upton, only to be sent to Wexham where he was kept waiting for ages. He got no antibiotics. He was told to go to his doctor if the wound got infected. It is bound to. MRSA anyone? We need more A&E units, not less. Less=longer waiting times for patients. We are told not to use ambulances for minor stuff but have no choice now.

Beryl Russell, Windsor, England

I have used local A&E units because my GP no longer provides an adequate service - it takes too long to get an appointment or they are not open at weekends. Added to this is the need to obtain monthly repeat prescriptions instead of 3-monthly, increasing cost and the pressure on GPs.
Where possible, I have used a local "cottage hospital" for dressings and mionor examinations. Very good, fast and friendly. The Tarporley war memorial hospital is brilliant.

The Government needs to listen to local concerns - not treat the NHS in the same way that it is treating the Sub-Post offices. End meaningless consultation processes.

And if it doesn't listen, use the ballot box - I now vote on the basis of local issues, not Westminster politics.

Alan, Tarporley, Cheshire, UK

A&E Departments in my area (Ilford) already have waiting times of anything up to six hours to be seen - and the local hospital with an A&E is under threat of closure. My concern is that they will close the department before making proper provision for the community. I cannot imagine that the remaining A&E department will be large enough to cope with double the doctors, double the nurses and double the number of beds/work stations. No, unfortunately the only thing that will double will be the number of patients in the waiting room.

Roz Bedford, Ilford,

I can understand having regional specialist A&E units to deal with trauma, cardiac, neuro etc patients with smaller units providing minor injury care however my concern is whether these specialist units will be properly funded or whether they will have to cope with extra workload but no extra resources

Karen, Wakefield,

There is a move afoot (courtesy of Patricia Hewitt) not only to close our local A & E department but the whole hospital leaving a population of several hundred thousand people having to travel between five and ten miles on some of the most congested roads in South London to another hospital where, having struggled through the traffic, there is almost no chance of being able to park - and this is progress!!!!!

Judith Webster, Carshalton, UK

The closure of any A&E department is a cause for concern. The NHS was founded on the concept of providing medical care as and when needed for everyone and any dimunition of this basic premise is to be deplored. We have now realised that the NHS cannot be all things to all people but surely the tax paying public, whose contributions fund the NHS, have the right to expect that, if and when we need urgent medicalk attention, such care can be provided in an A&E department close to where we live and should not involve a lengthy and possibly life threatening journey to some regional medical centre. Accidents happen all the time, they are not planned or predictable, and there should be medical facilities available to respond to need.

Judith, London,

How absurd this all is. Who suggested to gullible politicians in need of a quick fix that A&E closures would better serve any community? Surely only the Treasury can believe this to be so.

Just as a supermarket has 'loss leaders' to promote business elsewhere in the store, so the country will inevitably have services such as hospitals, schools and prisons that will be a drain on the economy but which are absolutely vital. Hospitals must not be open to culling for the convenience of slow-witted parliamentarians out of ideas.

Why are our elected representatives incapable of properly organising the structure of the NHS to make the service work? Instead they build up the bureaucracy and cut the very services for which the NHS was established in the first place and which the electorate - remember them? - deserve and pay for.

What will inevitably happen will be the A&E closures, then the deaths attributed to those closures. Then the politicians will defend the NHS, their decisions, but mostly their jobs; then there'll be the flagship projects to demonstrate clear commitment to the health service, choice, the future, what the people want... Then there'll be more deaths, so some politician somewhere will propose opening new A&E wards around the country at a cost of trillions.

Governments are very good at building bureaucracy. Charges for this, taxes for that, get new departments to levy the loot instead of using extant systems. I'm convinced the people running these things cost more than the money they were intended to raise.

Let's examine ways of cutting the cost of running the beast and ease up on sacrificing services such as the NHS and the people who pay for and use them. I'll vote cheerfully for the next guy who talks sense and can tie his own shoelaces.

Barry Lane, Eastbourne, East Sussex

I work in the NHS and am sick to death of political scaremongering about hospital reconfiguration.

The fact is that many A&E departments are struggling to provide high-quality care for the very sickest patients because it's just not feasible to have staff with these very specialist skills in every hospital in the country. In order to maintain their expertise, clinicians need to be practising these specialist skills more regularly than they can in a small district general hospital serving a population of 100,000 people.

When clinicians and NHS managers talk about reducing the number of A&E units, they're not saying there won't be any services available at people's local hospitals. What they're saying is that the vast majority of people will still get cared for at their local hospital, but that the very sickest patients will travel slightly further to get better, more expert care, in a larger unit.

Politicians should stop spreading misinformation in a cheap bid to win votes.

Maria, Manchester,

The closure of more yet more A&E departments will yet again increase the average waiting times from 4 hours to God knows how long. This isn't acceptable. Nowhere else in Europe do you have to put with such appalling waiting times.

Sabrina, Liege, Belgium

The logic of this defeats me. It's normal at peak times to have to wait 4 or 5 hours to be attended to in the existing A & E clinics. Reducing the number of clinics will result in, what, waits of 6 or 7 hours? More?

Then what about country areas with large geographic spread but relatively small populations? 45 minutes or more to drive to the nearest A & E?

Unfortunately, the private alternative isn't available for accidents, and now that GP's keep banking hours, more and more people are having to use hospitals who previously would not.

What an utterly useless government this is. Everything it touches turns to dross.

Martin, London,

It turned out that in order to improve access to superior quality health care, based on need and free at the point of delivery, we had to close all the local hospitals. This then made access difficult, so we had to install an enormous computer system to do scheduling. This then required more and more administrators, so we had to strive to save money by prescribing less drugs and reaching 99% bed occupancy. This then led to lawsuits, so we needed more money for compensation and had less to hire doctors.

There were then so few treatments predictably available that people kept offering to pay more, just to get treated. We explained to them that would lead to a two level system and rationing. We were sorry, equality demanded that they do without.

Why did they vote us out of office, it all seemed so reasonable?

George Johnson, London, UK

All of our smaller A&E units in Wiltshire are being closed or downgraded. People will have to have to travel either to Salisbury, Swindon, or Bath. Swindon and Bath are already a concretes jungles where parking is almost impossible and with a Regional Ambulance service rarely meeting it's 8 minute target arrival times lives will be lost when they could have been saved.

These closures are not about improving patient care. They are about saving money and it is the rural communities who will suffer most as they always have under this shambles of a Government.

Patricia Bryant, Chippenham, UK

"This country is rapidly going to the dogs."
Michael J Rigby, Blackburn, England

What do you think are the real chances of half of all A&E departments closing and us all being left in the lurch? This is yet another case of media scaremongering that we have to put up with in the UK. I suggest its the quality of UK journalism that is rapidly going to the dogs. This is the same David Rose that was moaning, late last year, about how much of a drain on the NHS alcohol related illnesses are. So A&E departments close and who suffers? Winos and teenage binge-drinking thugs - my heart bleads...

Rod Munch, Northampton, UK

Number crunching is the art of accounting, but as with most industries, when the number crunchers get their way you usually see a significant drop in key performances / sales related to that business. The NHS is not a business, people are not a commodity,
? are new labour really old conservatives in disguise !

Nigel Tims, wimbledon london, England

Why don't we go the whole hog and have one rather large A&E department in Rugby, in the centre of the country and equidistant from most of the population. That would be efficient and far sighted.

Neil Marshall, Cambridge, UK

Well I agree with the aparant views of this particular article, in the sense that catchment areas alone cannot be and should not be the only reason behind the NHS cut of A and E departments. Something should be done to try and rectify this and to include other reasons for doing so. As there are many other factors as well as those already mentioned which should be taken into account.

Monica, Bristol, England

This country is rapidly going to the dogs.

Michael J Rigby, Blackburn, England