Urgent and emergency services - Health Committee Contents

4  Restructuring

Specialist centres of care

57. The question of restructuring emergency services is fraught with local sensitivity, as patients and the public value the feeling of accessibility to local services.

58. There is, however, an unquestionable need to restructure the way urgent care is delivered across the health service. Among the most obvious drivers of this requirement to restructure is the recognition that only 17% of emergency departments in England are currently able to provide a minimum of 16 hours per day of consultant cover during the working week. If patients who need access to emergency trauma care are to receive a high quality service it is essential that this scarce consultant resource is used more effectively, and that the system is better at delivering all forms of urgent care, including care that is urgent but non-acute.

59. Professor Willett told the Committee that by regionalising services and bringing together care for particular illnesses and injury in specialist centres the health service "can give not 12 or 16-hour but 24 hour specialist input" which produces a dramatic improvement in the outcome for patients."[56] The Department of Health's written evidence detailed the clinical benefits of creating specialist units and regional trauma networks based around core trauma centres.[57]

60. The support for these measures is echoed by the British Medical Association, the Royal College of Surgeons and the Royal College of Physicians and the Committee is satisfied that the evidence base exists to support the Department's broad objectives in this area. Nevertheless, Ministers and parliamentarians must be aware that it is not possible to make a convincing case for necessary reorganisation unless they are frank about the implications for patients.

61. Regional trauma centres and specialist units catering for specific conditions must be developed as part of the hierarchy of care in each local area. The hierarchy must account for local structures and demand and also make allowances for the distinctions between urban and rural locations. The CEM argued in their written evidence that the benefits of regional centres for patients in rural areas could be entirely negated by increased transport times.[58] These observations merely reinforce the requirement for local commissioners to develop a fully integrated service which responds quickly and effectively to patient need.

62. The Committee accepts that a strong case has been made for the centralisation of some aspects of acute emergency care in regional specialist emergency units on the basis that substantial clinical benefits are delivered by focusing skills and resources in single locations. We are, however, concerned that this evidence is not abused; each proposal for service redesign should be reviewed on the basis of the evidence so that centralisation is justified only when the evidence supports it, not as an end in itself. For example, in rural areas the benefits of centralising care for some serious conditions could be negated by increased transport times.

63. Some of the evidence submitted to this inquiry drew a distinction between the short-term and medium-term response to the challenges facing emergency and urgent care. A better coordinated response to the current pressure is required to manage the immediate pressures, but in reality this is a continuous process. Medium-term plans for improvement should represent a coherent development of short-term responses while retaining sufficient flexibility to allow them to reflect changing circumstances.

64. Furthermore, there is an urgent need for clearer messaging to improve public understanding of the system and confidence in it. One of the benefits of the NHS should be a clear and familiar national formula for access to urgent and emergency care. The existing system is opaque and must be much more clearly defined.

56   Q 301 Back

57   Ev 73-75 Back

58   Ev 95 Back

previous page contents next page

© Parliamentary copyright 2013
Prepared 24 July 2013