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Less is more: Fewer A&E departments means better patient care

Four in 10 people visiting A&E last year needed no treatment

Sir Bruce Keogh deserves a round of applause. The NHS Medical Director’s report on emergency care – published yesterday – finally sets out in black and white what many in Westminster and the health sector have known for some time, and yet refused to acknowledge.

Sir Bruce notes that accident and emergency departments are creaking under the strain of an ageing population with ever more complex health problems. To solve the problem he recommends the creation of a two-tier system, with treatment of life-threatening conditions concentrated in specialist centres, and those not needing the same expertise or equipment dealt with elsewhere.

In fact, the proposal is not as radical as it sounds. It is a myth that all A&Es are the same; there has long been a gulf between those that provide the most up-to-date medical care and those that do not. What Sir Bruce wants is simply more of the same, then; plus more people treated closer to home, either by paramedics or GPs, and better triage by the 111 telephone service to help keep people out of hospital at all.

How right he is. Four in 10 people visiting A&E last year needed no treatment, and half of all 999 ambulance calls could have been dealt with at the scene. Furthermore, since London stroke victims started going to one of eight specialist centres, rather than their local casualty, the capital has become one of the best places in the country for a cerebrovascular accident.

If the benefits of specialisation are so obvious, why has it taken so long for it to get this far? Because of politics. It is a staple of grassroots campaigning to fight tooth and nail against the closure of any department of the local hospital, and MPs with an eye on the next vote often lend their support.

It can only be hoped that Sir Bruce can tip the balance. Not only can the NHS not afford to stick with the district general hospitals of the past; changing demographics and changing medical techniques make it undesirable to do so. Rather than giving in to the mob, MPs should be out there explaining why fewer A&E departments, say, actually means a better service. Sir Bruce has prepared the ground well.