Have your say: is there a case for A&E reform?

Read the Times Health Editor's analysis of the A&E debate

Ways to treat a heart attack and stroke

The closure of accident and emergency services at some hospitals is in the interests of patients, the Government said yesterday.

Presenting them as part of a plan to create “super-A&Es” to deal with heart attacks, strokes, and aortic aneurysms, Patricia Hewitt, the Health Secretary, sought to halt a tide of opposition to the closures.

They were not about saving money but about saving lives, she asserted.

If that were true, Andrew Lansley, her Conservative opposite number retorted, it could have been done before, not after, financial deficits in the NHS had come to light.

The Department of Health published two reports to support the claims by Ms Hewitt. They called for “reconfiguration” of A&E services, to allow specialist centres for the most serious conditions to be created, and enable more people to be treated in their homes.

According to Professor Roger Boyle, the national director for heart disease and strokes, local A&E units are not the best places for providing good care for patients suffering from either of these conditions.

Specialist centres might mean a longer journey for many people, but they would produce better results, saving the the lives of 500 people suffering heart attacks every year, preventing 1,000 further heart attacks and saving 1,000 more stroke victims from death and disability, he said.

Sir George Alberti, the national director for emergency access, said: “We have to be up front and tell the public that, in terms of modern medicine, some of the A&E departments that they cherish are not able to provide this type of care and cannot and will not be able to provide the degree of specialisation and specialist cover that modern medicine dictates the public deserves.”

It would be better, he said, for many patients to bypass the local hospital and be taken by highly trained paramedics to specialist centres. “ ‘But won’t I die on the way?’ many people ask,” he said. “No, you won’t. Long ambulance journeys do not lead to more deaths.”

Ms Hewitt said: “Whenever the A&E starts to talk about reorganising, people think it’s all about money and it isn’t. It’s about saving more people’s lives, it’s about making care more convenient, it’s about getting the money into the right place so that people get the best care from the right person at the right time.”

The Government fears that it is losing the argument over NHS reconfigurations, which involve A&E and maternity services, among others.

The reports, published yesterday, are designed to present the issue more positively, by showing that change might not mean worse care.

But the argument assumes that the money saved by closing some A&Es is devoted to building others into specialised centres. That is not guaranteed.

Karen Jennings, the head of health at the public sector 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.

“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 the 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.”

Mr Lansley did not dissent from the idea of specialist units, which he has championed for some years. But he said that the patients who would be sent to them represented, at most, 5 per cent of all A&E attenders.

“I accept the need for specialisation, but this should not be used to justify taking accessible A&E departments away from district general hospitals,” he said.

Ms Hewitt said that casualty services in future would divide into three kinds, with “super- A&Es” for people with the most serious conditions, local A&Es for most treatment and the A&E that “will come to you” for less serious injuries.

“Financial problems are forcing people to look at changes they ought to be doing anyway, and in a few cases financial problems are driving people to make changes they should have done years ago,” she said.

The report by Sir George Alberti arrives at a similar conclusion. “Finances may have been the issue that drew the media’s attention, but they are not the reason for reform,” it said. “Reforming emergency care is about responding to medical advances and providing new and better services in ways that allow the NHS to save more lives.”

Beverly Malone, the general secretary of the Royal College of Nursing, said: “Any changes must be subject to full and proper consultation with staff, unions, patients and local communities — after all, it’s our NHS and we all deserve a say in how it is run and reformed.”

Under threat?

The Government has not produced a list of trusts where A&E departments have closed or are threatened. But the Tories say they have identified hospitals in 29 NHS trusts:

Worthing and Southlands Hospitals

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