The Daily Telegraph reported this week that a group of senior doctors at nine NHS trusts in London have written to the Health Secretary to call for urgent changes in the provision of A&E services in the capital. They call for four A&E departments to close and be replaced by Urgent Care Centres (UCCs) – which would handle less serious cases – and for A&E resources and expertise to be concentrated in fewer centres of excellence. The objective is to improve quality of care seven days a week.
The story comes ahead of Professor Sir Bruce Keogh's report next month on national benchmarks for emergency care and improved standards in healthcare for every day of the week. News reports in recent months have frequently highlighted wide variations in care at weekends and this has become a common trend for many of the cases we see where patients complain about A&E care.
The senior medics argue that to provide the number of staff and experience needed to deliver consistent quality of care all week means fewer, larger hospitals. They warn that if this is not done – and urgently – lives could be lost. According to The Daily Telegraph, any further delays risk patient safety leaving fragile services at some hospitals that are neither clinically nor financially sustainable.
The plans also extend to some intensive care, maternity and children's units. The BMA said yesterday that it supports changes that would see more senior doctors working in the evenings and at weekends to improve emergency and urgent care. The Daily Telegraph reports that local GPs in London are also urging the Health Secretary to adopt the changes.
The proposals have, however, been opposed by local groups where A&E units are in question. Ealing Council in West London has made representations opposing the closure of the local A&E department, which it claims would see an estimated one-third of blue light emergency transfer taking longer to reach hospital.
The Health Secretary is due decide any day on what changes will be implemented in London, with the rest of the country looking on to see what nationwide plans may follow.
Commenting on the latest reports, Andrew Clayton of the clinical negligence team at Penningtons Manches, said: "These changes offer the potential to deliver better quality emergency care to patients with the some of the gravest traumatic and life-threatening injuries. We encounter many patients who have received sub-standard A&E care because they were seen during the night or at weekends when the staffing and resources simply could not deliver.
"There is clearly a balance to be struck between focussing resources on so-called centres of excellence and ensuring that patients are not so far away that their care is geographically compromised. Key factors will include increasing resources for other emergency care providers, particularly ambulance services, and improving patient education to improve their understanding of where to go for different care needs.These are all areas in which the NHS has a rather uneven recent track record."