Two tier system proposed for English accident and emergency units

999 emergency departments would provide a full range of services, while 111 could be used for second rank emergency departments

A two tier system of accident and emergency units has been proposed for England as part of a major re-organisation of NHS emergency care.

Some units could be designated “999 emergency departments” providing the full range of services and able to cope with all cases while “111” (the new phone number for non-emergency care) could be used for second rank emergency departments, which would provide fewer services and less consultant cover. 

The 111 units would have links to the top tier departments to transfer seriously ill patients swiftly when necessary.

The draft plan for a two tier national A&E service, leaked to the Health Service Journal, was completed in the autumn following a two year review.  It says the existing system of walk in centres, urgent care units, out of hours GP organisations and A&E departments is “fragmented and confusing” and that a standard name should be used for each level of care.

The controversial proposal in a draft document from the Department of Health emerged as Jeremy Hunt, the health secretary, prepares to announce his decision on the fate of Lewisham Hospital’s A&E in south London, which has become a touchstone for reconfiguration decisions across the NHS.

The A&E unit at Lewisham has been recommended for downgrading, along with the maternity department, following the failure of the South London NHS Trust which is effectively bankrupt after running up repeated deficits, the latest being £65 million in 2011-12.

Although Lewisham is not part of the trust, there are full A&E departments  at hospitals in Greenwich and Bromley, which are part of the trust, but which cannot be closed because they have  expensive PFI deals which cannot be undone.

The proposed closure of Lewisham, on cost rather than clinical grounds,  has infuriated local residents, doctors and politicians who say it is being sacrificed for the failings of the neighbouring trust and 15,000 marched in its support last weekend.

William Hague, Chris Grayling and Iain Duncan Smith are among coalition government ministers who have intervened to oppose threats to local A&E and other services in their constituencies.

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