Monday, 12 January 2015

Amid fears of more A&E closures Britain's top emergency doctor warns that shutting casualty units puts patients' lives at risk

  • Doctor says NHS bosses must urgently rethink plans to shut units
  • Warning comes amid fears new wave of A&E closures could sweep NHS
  • Last week, 17 hospitals across England declared ‘major incidents’
  • Doctors shut doors on ambulance crews with patients, paramedics claim
A&E departments are so busy that closing more will cost lives, Britain’s top emergency doctor has warned.
Dr Clifford Mann said NHS bosses must urgently rethink any plans they have to shut casualty units because it will ‘risk patient safety’ – and take patient care into ‘uncharted territory’.
Dr Mann’s comments come amid fears a new wave of A&E closures could sweep the NHS after May’s General Election, despite the unprecedented demand and longer waiting times for emergency treatment.

Warning: 'Given current demands... any further reduction in their number would be a potential risk to patient safety,' said Dr Clifford Mann (pictured), president of the College of Emergency Medicine

For more than two years, The Mail on Sunday has campaigned against casualty closures, which health bosses and doctors have argued are necessary. 
But the changes often lead to patients who need urgent treatment travelling further in ambulances or being told to go to a centre staffed by general doctors and nurses, rather than specialised units.
Last week, 17 hospitals across England declared ‘major incidents’. 
Some A&Es were so full that doctors shut their doors on ambulance crews trying to bring in seriously ill patients, paramedics claimed.

Dr Mann, president of the College of Emergency Medicine, said part of the reason for this winter’s chaos was that England’s network of A&E units had shrunk in the past decade, even though demand had ballooned.
Over the past ten years the number of people attending fully staffed and equipped A&Es has jumped 13 per cent to 14.2 million. 
That is equivalent to the number of patients treated annually by 25 A&E departments, according to a report by the highly-respected Nuffield Trust think-tank.
But instead of building more, 13 A&Es have been closed since 2005. 
They have been downgraded to ‘urgent care centres’ (UCCs) or ‘minor injury units’ (MIUs), which cannot deal with serious illness or injury. Some are closed at night.
Nine of the 13 A&E closures have occurred under the Coalition government. 
Most recently, two were downgraded in west London last September, and figures now show A&E waits have spiked at nearby Northwick Park Hospital, to which patients are being transferred.
England now has 181 A&Es, which health bosses argue is still too many, saying the evidence from cutting smaller stroke, heart attack and trauma units is that centralising emergency services saves lives. 

Closures: Across England since 2005, 13 A&Es have been 'downgraded' - meaning they were closed and replaced with urgent care centres or minor injury units

But Dr Mann said English A&Es were already ‘incredibly busy’ by international standards – and that widespread closures would worsen the situation. Around a dozen A&Es are thought to be under threat.
Dr Mann said: ‘In England we talk about a small emergency department being one that deals with 60,000 patients a year. 
'But in the US, Australia and much of Europe that would probably be the largest emergency department in the country.’ 
The combined effect of increasing demand and the 13 closures means the ‘average’ English A&E now sees 78,500 patients a year – up 13,000, or 20 per cent, since 2004.
Dr Mann said: ‘The idea we need to reduce the number of emergency departments and centralise more services, seems to me a fairly brave statement given we are already at one end of the scale, when you compare us internationally. Given current demands on our emergency departments, any further reduction would be a potential risk to patient safety.’
A year ago, NHS England unveiled a controversial plan to develop 40 to 70 ‘major emergency centres’. 
NHS England medical director Prof Sir Bruce Keogh insisted this would not result in closures, but critics said it would lead to a ‘two-tier’ A&E system in which smaller units suffered. 
Insiders say the scheme has been put on ice over fears it amounts to ‘political suicide’ – a claim denied by NHS England. But it is believed the plan will be revived after May.
Dr Mann said: ‘We have succeeded in creating large emergency departments that give us economies of scale, and concentrate expertise. 
'But to go any further is to go into uncharted territory globally.’
Dr Mann stressed he was not against every single downgrade and said ‘rationalisation’ sometimes made sense. 
But just because centralising stroke, heart attack and trauma units had worked, that did not mean the same approach would benefit the other 95 per cent of A&E patients.
Latest weekly statistics show only 79.8 per cent of patients attending England’s 181 A&Es were treated within four hours. The target is 95 per cent. 
Dr Sarah Pinto-Duschinsky, of NHS England, said: ‘The NHS continues to face unprecedented pressures on frontline services. Flu is at its highest for the last three winters.’


The NHS is under so much strain, medical students are being drafted in to do unpaid hospital shifts, The Mail on Sunday has learnt.
Fifth-year students at Leeds University have been asked to ‘undertake extra shift and weekend work’ in local hospitals, according to a leaked email from Professor Paul Stewart, dean of its medical school. 
Students are not being forced to do the extra shifts, which come on top of their normal placements, but Prof Stewart wrote: ‘We have no doubt you will rise to the occasion.’
Students last night said they were keen to help. But one said: ‘There is no way of dressing this up as anything other than desperation.’
Volunteers will get travel expenses and a ‘subsistence’ allowance.


For more than two years The Mail on Sunday has campaigned to save A&Es from closure. We have cut through NHS and ministerial spin to show how shutting departments has led to neighbouring hospitals becoming gridlocked, while towns have been left with inadequate services.

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