NHS Guidance of one A&E unit per 450,000 people would be a disaster for Cumbria

I am deeply alarmed at suggestions that at least some some health authorities have been advised that the catchment area for NHS Accident and Emergency Units should be between 450,000 and half a millon people.

If applied in Cumbria this would mean the closure or downgrading of at least one and possibly two of the three A&E units in the county. We currently have A&E facilities at the West Cumberland hospital in Whitehaven, Furness General hospital in Barrow, and Cumberland Infirmary at Carlisle, serving a population which is nowhere near enough for even two A&E units, never mind three, if this target were strictly applied. Given that part of South Cumbria obtains A&E services from Lancaster Infirmary, the population of the whole of the rest of Cumbria is about equivalent to the proposed catchment area for a single A&E unit.

Over the North West as a whole, there are currently 33 Accident and Emergency units for 6.8 million people. Of these no fewer than 18, which is well over half, would have to be closed or downgraded to bring the average catchment area up to 450,000 people.

Such a policy appears to be completely absurd, especially as there is no clinical advice or basis to justify the proposed range of 450,000 to 500,000 residents. Yet the Department of Health does seem to have ordered at least some Health authorities to design Accident and Emergency services so that each major A&E department serves a population of at least 450,000 people. The guidance has been referred to in strategy documents prepared by local NHS organisations in Surrey, 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.”

(West Surrey NHS, Clinical options workshops, March 2007; http://www.conservatives.com/pdf/AEcuts.pdf)


A staff briefing by the Surrey Primary Care Trust in March 2007 similarly confirms that:

“National guidance – full A&Es to serve a catchment population of 450,000-500,000 people.”

Source: Surrey Primary Care Trust, Creating an NHS fit for the future: staff briefing, March 2007; available at: http://www.transition.surreypct.nhs.uk/fit-for-the-future-briefings/Fit_for_the_Future_Staff_briefingsMarch_2007.ppt.

The figure of 450,000 appears to have been plucked out of thin air, and is not the figure recommended by those leading clinicians who do support the idea of a minimum recommended catchment population.

For example, the Royal College of Surgeons of England published in March 2006 the document
"Delivering High-quality Surgical Services for the Future", which recommended a minimum catchment population of 300,000.

Even the Royal College of Surgeons proposals could, if implemented in a more rigid way that I hope and think they are actually suggesting, have dire consequences for Cumbria. The latest DOH guidance as quoted in the Surrey documents would be far worse.

However, other leading doctors take a broader view of the needs of less densely populated areas and also suggest that the number of patients treated, not population, should be the main guide to the size required for a viable service.

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.

Cumbrians should demand an assurance from our local Strategic Health Authority and PCT that the target of 450,000 to 500,000 people per A&E unit referred to in the Surrey documents will not be applied in the North West. If no such assurance is forthcoming, we have a real problem.