A&E Services: NHS Plans Two-Tier Service

By Thomas Moore, Health and Science Correspondent

Scores of A&E departments could be downgraded under radical plans to create a two-tier emergency health care system proposed by the NHS medical director.

The plans would see the country's casualty units reclassified as either "emergency centres", which would assess patients and start treatment, and "major emergency centres", which would provide specialist care such as for strokes or heart attacks.

Under the proposals between 70 and 100 hospital A&E departments would offer reduced services as "emergency centres" and between 40 and 70 would be classified as the specialist centres.

It would mean patients in some parts of the country facing longer travel times to receive specialist emergency treatment. However, it is argued that they would be getting the best treatment.

The review would represent the biggest shake-up of A&E services in the NHS in 40 years, according to NHS England officials.

Professor Sir Bruce Keogh, the head of NHS England, insisted the changes were not about closing local A&E departments but abut creating a safe service that could cope with increasing demand.

Sir Bruce said "doing nothing is not an option".

"We are here really because A&E is creaking at the seams. It's not broken but it is struggling.

"In many senses, our A&Es have become victims of their own success because they function as a safety net for people who are worried, frightened, anxious or in pain and therefore have problems that concern them.

"When A&Es become very busy it means other parts of the system are creaking as well, they are under stress.

"It's against that background that there's a feeling this winter will be difficult."

The plans would see the development of specialist emergency care centres

Other significant measures included in Sir Bruce's review include:

:: Paramedics being specially trained to treat 999 patients at home rather than simply transporting them to hospital.

:: Patients with minor problems would be given more support to look after themselves.

:: The roundly criticised 111 phone service would be enhanced with patients speaking directly to doctors and nurses.

:: Seven-day appointments with GPs.

It will be five years before any overhaul is completed, if it goes ahead, but there have been warnings that the NHS is facing its toughest winter ever and critics say that looking into the future will not solve the crisis facing the country now.

Shadow health secretary Andy Burnham said: "This is an issue affecting every man, woman and child in England and, on the brink of a dangerous winter, it's just not good enough to have a Government acting as a spectator on the sidelines blaming everyone else.

"Ministers said this report would have lessons for the immediate winter as well as the longer term.

"But they are failing to act and their response remains 'crisis, what crisis?'. They are forcing A&Es to go into winter with too few nurses, doctors and beds."

The College of Emergency Medicine said the review looked to the future when "the crisis is here with us now".

Health Secretary Jeremy Hunt told the Commons on Tuesday that the review would not shy away from taking "difficult decisions".

"We all know that the NHS needs to change to meet the needs of an ageing population," he said.

Some A&E departments could end up dealing with less serious injuries

Earlier this week, Downing Street confirmed that Prime Minister David Cameron was getting personally involved in overseeing the NHS's response to the winter pressure on A&E departments.

In 2012/13, more than a quarter of all patients attending major A&E departments were admitted to hospital, up from 19% in 2003/04.

There will now be consultation on the plans and the review team will assess the cost and impact on staffing before producing another report in the spring.

Dr Clare Gerada, head of the Royal College of General Practitioners, gave the plans a cautious welcome.

"Of course it's important that patients get the same quality of service on a Sunday afternoon as a Tuesday morning," she said.

"But it's equally important that in the quest for seven-day working we don't remove resources from where they are best used, which is in general practice, and when patients see us most, which is in the working day."

In some parts of the country specialist paramedics are already in action. The South East Coast Ambulance Service already has some 'paramedic practitioners', who keep 30,000 patients a year out of A&E.

Sky News spoke to 92-year old Gwendolyn Kimpton, who had a badly infected wound dressed by one of the paramedics.

She said she was relieved not to be going to hospital: "I would have been a bit frightened, I must admit."

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