Proposed A&E Guidance: Department of Health responds

The Department of Health has responded vigorously to reports and comments about the proposed guidance suggesting that full Accident and Emergency departments should have a catchment area of 450,000 to 500,000 residents.

A Department of Health spokesman said yesterday that the figures were "wrongly interpreted" by the NHS trusts in Surrey which had referred to them as "national guidance". He said that there was no such official guidance from his department.

However, he admitted that the recommendations were taken from a report by the Royal College of Surgeons supported by Sir George Alberti, the former director of emergency care. Sir George recently recommended the closure of an A&E department in north London. The remaining two A&Es serving the area will be left with catchment populations of 450,000 each.

The Department of Health has described the report as "guidance in a consultation document" and added that "The DH receives guidance from all manner of bodies and expert groups but this is not secret DH guidance and we are not forcing the NHS into 'closing' 92 A&Es."

The full text of the Deparment of Health response reads as follows:

"It is complete nonsense to suggest that half of all A&E's are marked for closure by the Department of Health. This is just wrong.

The Royal College of Surgeons of England reconfiguration working party issued guidance in a consultation document and this is the guidance to which the opposition refer in their document. The DH receives guidance from all manner of bodies and expert groups but this is not secret DH guidance and we are not forcing the NHS into 'closing' 92 A&Es.

Any decisions about the shape of A&E services are taken locally so that services reflect the needs of the local population. Where local health authorities believe that patients can be better served by changing the way services should be delivered, it is right that they make those changes, and they will consult locally on any proposals.

Patients across the country have seen the transformation of A&E services in the last ten-years, with record investment and innovative new ways of working resulting in an end to the long delays patients used to experience. Increasingly, emergency care is being delivered at different levels - through walk-in centres, minor injury units and specialist units to treat conditions such as stroke as well as in A&E departments.

In many areas hospitals are changing because medicine is changing. The most specialist care (eg primary angioplasty for a heart attack) needs specialist teams and can't be done in every local hospital. If we know that the NHS can improve and save more lives by changing services, we would be betraying patients if we refused to support change just because it's difficult.

Far from closing hospitals, we have already opened or are building over 100 new or refurbished hospitals - with more to come. We are investing another £750 million in new community hospitals. We have refurbished over 2800 GPs' premises and opened 106 new primary care centres."

I am of course pleased to learn that the Surrey NHS Trusts which referred to this document as "national guidance" had apparently misunderstood the status of its recommendations. However, I make no apology for raising the issue.

Indeed, now is the time to make a fuss - before the Royal College of Surgeon's working party recommendations do get adopted as national guidance. Because if these recommendations were adopted as guidance by the Deparment of Health, and were rigidly applied by Strategic Health Authorities and local NHS trusts, the consequences for Cumbria and many other parts of the UK would be every bit as dire as suggested in my previous post.