Will the planned A&E closures lead to more mistakes?
Doctors working in accident and emergency say plans to downgrade some services are based on flawed evidence.
The College of Emergency medicine says it's wrong to assume that most patients coming to A&E can be seen elsewhere and that investment in separate walk-in and urgent care centres is misguided and wasteful.
Campaigners who have protested against the replacement of A&E departments with clinics for minor injuries welcomed the report. The future of many A&E units is coming under scrutiny as health trusts seek to concentrate some highly specialised care in fewer hospitals.
The College of Emergency Medicine says many plans are based on an assumption that's "simply untrue" - namely that 60% of people coming to A&E have relatively minor problems that could be sorted out elsewhere, for example in minor injuries units or polyclinics. The college's president, Dr John Heyworth, says the 60% figure is "fiction". "It is a mantra which has driven strategy for a number of years, but our evidence from the college of emergency medicine and other evidence from recent research has confirmed that it's nowhere near 60%."
A report earlier this month by the Primary Care Foundation said the true figure was between 10% and 30%. Dr Heyworth says this proves that most patients going in to A&E need the expertise and resources that can only be offered by a hospital emergency department. Surely if that department is not available, with the correct staff on hand, more mistakes will happen. He said: "We need to strengthen our emergency departments and if we want to consider different strategies they must only be on the basis of robust, reliable clinically-led evidence - and at the moment that's not applying in many places."
The college is issuing a manifesto, calling for a substantial increase in the number of emergency medicine consultants. It wants to bring their staffing levels up to 10 for an average-sized A&E unit, so they can provide cover at evenings and at weekends. It says this would help save money for the NHS by reducing inappropriate hospital admissions and unnecessary investigations.
Health campaigners fighting plans to scale down or close A&E units have welcomed the manifesto.
John Lister from Health Emergency said ministers should heed the advice of the "real experts" in emergency medicine. He said: "For far too long policies have been driven not by these clinicians but by evidence-free assertions by health service bureaucrats or management consultants who have claimed that up to 60% of A&E caseload could be switched to primary care", adding that "policies based on false assumptions had wasted management time and diverted attention away from the proper ways to improve A&E departments, resulting in more errors and patients not receiving the right treatment."
He called for an inquiry into where the 60% figure came from in the first place.
Dr Andrew Hobart, from the British Medical Association's Emergency Medicine Committee, agreed that assumptions behind the re-organisation of urgent and emergency care were "fundamentally flawed". But he said there was still a case for some re-organisation. "In some metropolitan areas it may be better to have slightly fewer all-singing-and-dancing emergency departments rather than more that are not so good," he said.
A Department of Health spokesperson said: "It is for the NHS locally to decide on ways of meeting patients' urgent and emergency care needs that deliver integrated, convenient, accessible, quality and safe care which is value for money. There is a wide choice of services available for people with an urgent care need, including urgent care centres, GP led health centres, walk-in centres and minor injury units. A&E services are part of the wider urgent and emergency care system. The NHS locally will ensure resources and clinical expertise are used efficiently and effectively across the system for the benefit of patients."
If you have experienced a mis-diagnosis or a member of A&E staff has failed to treat you in an appropriate manner with regard to your specific injury, then please call Boyes Turner's medical negligence lawyers. We can offer you advice on whether you are able to bring a claim for compensation.
Consistent with our policy when giving comment and advice on a non-specific basis, we cannot assume legal responsibility for the accuracy of any particular statement. In the case of specific problems we recommend that professional advice be sought.
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