Two tier A&E within the NHS

29 November 2013

David Beeson, Healthcare Product Manager,  Northgate Public Services

The government has announced a move towards a two-tier Accident and Emergency service within the NHS.

Sir Bruce Keogh, Medical Director of NHS England, launching his report into A&E, proposed a move towards having no more than half the present 140 centres in England, and perhaps as few as 40, designated as major A&E services, equipped to handle strokes, serious cardiac problems or major trauma. The other 70 to 100 would handle only the less complicated cases.

The concentration of high-level expertise in a smaller number of centres should help improve the service patients receive there. Already in London, for example, just eight out of 32 hospitals offer stroke care. That means an ambulance would take a stroke patient to one of those centres, where the best level of care would be available, even if that means bypassing a closer hospital.

Jeremy Hunt, Health Secretary, made it clear that he saw the Keogh plan as the best way of ensuring stability in A&E services, by providing a long-term future for all the centres, none of which would close as a result of the reform.

However, Sir Bruce Keogh was clear that this step would not on its own solve the problem of ‘intense, growing and unsustainable pressure’ on A&E services. That has to be achieved by concerted efforts to reduce demand which, in turn, means diverting less ill patients to healthcare in the community, whether by GPs or from other services.

In that respect, it is interesting that his proposals also involve enhancing the 111 service, by giving it access to medical records and using it as a means of putting patients directly in contact with a medical professional.

This comes alongside an initiative to make more paramedics available to call on patients at home: they could refer serious cases to hospital, but might in many instances be able to treat the patients then and there. If they can, this is likely to mean a better experience for the patient as well as a less expensive form of treatment, a powerful illustration of the counter-intuitive but common fact that the best healthcare, far from being the most expensive, can be the cheapest.

For the Opposition, Labour health spokesman Andy Burnham has spoken out against the closure of Walk-In centres, where patients can obtain GP care without an appointment. That is a debate which is only just beginning and is likely to run for some time: how cost-effective are the centres? Do they deserve to be kept open? Above all, do they have an impact in reducing pressure on A&E services?