Concerns raised over threat of A&E hospital cuts in Harrow - Bob Blackman
A&E must have catchment areas of half a
million people suggests report
Bob Blackman, Harrow East Parliamentary Spokesman and London Assembly Member, expressed grave concern at reports that
the 92 of England’s 204 Accident and Emergency departments could be axed – if Labour
press ahead with plans to force A&Es to serve an area covering at least 450,000
people.
Currently A&Es typically serve an area of under
250,000 people, but NHS organisations are pressing ahead with plans to close
down A&Es, saying that they have been instructed to by the Department of
Health. If A&Es are forced to serve
450,000 people, this would mean cuts of fifteen in London. The
plans also fly flies in the face of recommendations by clinicians.
Bob Blackman said:
“Access to Accident &
Emergency services is a vital component of the quality of NHS services. There
is no clinical evidence which would justify shutting down A&E departments
simply because they don’t serve a catchment population in excess of 450,000.
Yet Whitehall bureaucrats are seeking now to justify closures on these grounds.
“Such closures are
being driven by financial deficits – thanks to Gordon Brown, who has been
controlling the NHS purse-strings. These latest Labour cuts to our NHS must be
resisted, yet I fear the Gordon Brown – as Prime Minister – is merely going to
offer more of the same.”
CURRENT NUMBER OF A&Es
There are currently 204 major (sometimes
referred to as ‘type 1’) Accident and Emergency (A&E) departments in
England, serving a total population of 50 million people. On average, each
A&E department serves a population of 247,214.
|
|
Number of major Accident and Emergency departments
|
Population
|
Catchment population of each A&E
|
|
North
East
|
14
|
2,558,308
|
182,736
|
|
North
West
|
33
|
6,846,249
|
207,462
|
|
Yorkshire
and the Humber
|
21
|
5,063,944
|
241,140
|
|
East
Midlands
|
12
|
4,306,335
|
358,861
|
|
West
Midlands
|
23
|
5,365,438
|
233,280
|
|
East
of England
|
19
|
5,541,636
|
291,665
|
|
London
|
32
|
7,517,726
|
234,929
|
|
South
East Coast
|
16
|
4,213,904
|
263,369
|
|
South
Central
|
12
|
3,950,320
|
329,193
|
|
South
West
|
22
|
5,067,794
|
230,354
|
|
England
|
204
|
50,431,654
|
247,214
|
The catchment populations of A&E departments
in each of the NHS’s Strategic Health Authority (SHA) areas varies widely. In
the North East for example, an average A&E department serves just over
180,000 people, while in the East Midlands an average A&E department serves
almost 360,000 people.
CUTS ON WAY: NEW DEPARTMENT OF HEALTH GUIDANCE
The Department of Health has apparently ordered
the NHS to design Accident and Emergency services so that each major A&E
department serves a population of at least 450,000 people, but only in London
and the South East. The guidance has been referred to in strategy documents
prepared by local NHS organisations, and by the Department of Health’s director
for emergency care.
A document prepared by the West Surrey NHS
confirms that:
“Current Department of Health and Strategic
Health Authority guidance suggests that to be viable in terms of patient need,
patient safety, staffing numbers and clinical training requirements, a full
A&E department in the future would need to be supported by a catchment
population of between 450,000 and 500,000 people.”
Source: West Surrey NHS, Clinical options
workshops, March 2007; available at: http://www.conservatives.com/pdf/AEcuts.pdf
A staff briefing by the Surrey Primary Care
Trust in March 2007 similarly confirms that:
IMPACT OF NEW GUIDANCE
If the guidance which insists that each A&E
department serves a minimum of 450,000 people is implemented, then the number
of A&Es required in each SHA area is listed below:
- The North West will require only 15 A&E departments, rather than
the 33 it currently has – suggesting
that 18 will need to be closed or downgraded.
- London will require only 17 A&E departments, rather than
the 32 it currently has – a decline of
15.
- The South West will require only 11 A&E departments, rather than
the 22 it currently has – a decline of
11.
- The West
Midlands will require only 12 A&E departments, rather than the 23 it
currently has – a decline of 11.
- Yorkshire and the
Humber will require only 11 A&E departments,
rather than the 21 it currently has – a
decline of 10.
- The North East will require only 6 A&E departments, rather than
the 14 it currently has – a decline of
8.
- The East of England will require only 12 A&E departments, rather than
the 19 it currently has – a decline of
7.
- The South
Central region will require only 9 A&E departments, rather than the
12 it currently has – a decline of 3.
- The East
Midlands will require only 10 A&E departments, rather than the 12 it
currently has – a decline of 2.
Overall, the total
number of A&E departments in England will fall from 204 to 112 – a decline
of 92.
The calculation is achieved through dividing
through the population of each SHA area with the catchment populations which
the Government wants each A&E to serve – 450,000. This is spelt out in the
table below:
|
|
Population
|
Forecast
number of major Accident and Emergency departments if each serves 450,000
people
|
A&Es
downgraded or closed
|
|
North East
|
2,558,308
|
6
|
8
|
|
North West
|
6,846,249
|
15
|
18
|
|
Yorkshire and the
Humber
|
5,063,944
|
11
|
10
|
|
East Midlands
|
4,306,335
|
10
|
2
|
|
West Midlands
|
5,365,438
|
12
|
11
|
|
East of England
|
5,541,636
|
12
|
7
|
|
London
|
7,517,726
|
17
|
15
|
|
South East Coast
|
4,213,904
|
9
|
7
|
|
South Central
|
3,950,320
|
9
|
3
|
|
South West
|
5,067,794
|
11
|
11
|
|
England
|
50,431,654
|
112
|
92
|
NO HEALTH GROUNDS TO SUPPORT CUTS
The figure of 450,000 appears to have been
plucked out of thin air, and is not the minimum recommended catchment
population made by leading clinicians.In March 2006, the Royal College of Surgeons of
England published Delivering High-quality Surgical Services for the Future,
which recommended a minimum catchment population of 300,000. It said that:
“The majority of acute hospitals currently have,
and are likely to continue to have, a catchment population of approximately
300,000. Some rural hospitals do not reach even this population mass, and yet
are still required to provide as full a range of services as possible…There
needs to be, in the first instance, strategically planned reorganisation so
that, where feasible, smaller hospitals are able to merge to achieve a
catchment population of at least 300,000.”
Other leading clinicians decide not to define a
sustainable Accident and Emergency department with reference to a hospital’s
catchment area, at all – but rightly use the number of actual attendances to
define demands on a hospital. The British Association for Emergency Medicine
and The College for Emergency Medicine, for example, demand that:
Hospitals with attendances at A&E in excess
of 40,000 per year should have, “immediate access to the key supporting
specialties to allow an emergency department to function safely. The following
should be available on site: intensive care, anaesthetics, acute medicine,
general surgery, orthopaedic trauma. There should be rapid easy access to child
health (preferable on-site), 24-hour access to imaging (including CT scanning)
and laboratory services available on-site”.
Even those hospitals with fewer than 40,000
attendances at A&E per year should continue to retain A&E services,
provided that, “they are able to demonstrate their effectiveness, safety and
quality”.
Source: British Association for Emergency
Medicine and The College for Emergency Medicine, Way Ahead 2005, 2005;
available at: http://www.emergencymed.org.uk/temp/1337-pubs_way_ahead_2005.pdf
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