Sir Bruce Keogh, NHS England’s Medical Director, has proposed the two-tier system for A&E services across England in a bid to cope with what he described as “intense, growing and unsustainable pressure” on A&E departments.
Speaking at a press conference on 12 November, Sir Keogh outlined plans to establish 40–70 “major emergency centres”, with the remainder of the 140 A&E departments catering to less severe cases in a bid to direct patients to the departments best able to treat them.
“Patients have gained false assurance that all A&Es are equally effective,” he said. “This is simply not the case.”
Sir Keogh said the plans presented a “sustainable solution” to the difficulties facing A&E departments and would provide clarity in an environment where “bolt-ons” – such as urgent-care centres and walk-in centres – had caused “a whole heap of confusion” about where to seek treatment.
In response to figures that suggest around 40% of patients attend A&E unnecessarily, Sir Keogh has called for a more responsive NHS 111 service to give patients access to doctors, and suggested that paramedics should be trained to provide more treatment at the scene.
Given the strong local resistance to hospital service changes, Sir Keogh took pains to stress that the two-tier system was not a “degradation” of services.
“These proposals are not about cutting existing urgent and emergency care services,” he said, adding that he expected “the overall number of emergency centres (including major emergency centres) to be broadly the same”.
The medical community has broadly welcomed the report, and Patients Association Chief Executive Katherine Murphy complimented its “promising vision” while Nigel Edwards, Senior Fellow at the King’s Fund, called it a “welcome dose of clarity”.
Others, however, have raised concerns that patients’ attachment to local A&E services could hamper the changes, and that the two-tier approach could result in longer journey times for critical patients.
Dr Clifford Mann, President of the Royal College of Emergency Services, suggested that the real cause of the crisis was a lack of staff, on which issue “the review is disappointingly silent”.
The proposals will be reviewed by a team of consultants before a further report is issued in 2014, with a view to implementing the changes within five years.