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
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