Hospital emergency departments are set to be reclassified into a two-tier system with around 40 offering a higher level of staffing and expertise, NHS England has revealed.
Sir Bruce Keogh, the body’s medical director, has published the first phase of his review of urgent and emergency care in England.
There are currently 140 non-specialist hospital trusts with type 1 A&E departments in England.
Under the new plans, the NHS will introduce two types of hospital emergency department with the current working titles of emergency centres and major emergency centres.
Emergency centres will be capable of assessing and initiating treatment for all patients and safely transferring them when necessary. Major emergency centres will be much larger units, capable of not just assessing and initiating treatment for all patients but providing a range of highly specialist services.
NHS England envisages there will be around 40-70 major emergency centres across the country. It expects the overall number of emergency centres – including major centres – carrying the red and white sign to be broadly equal to the current number of A&E departments.
The review report stated: “These proposals are not about cutting existing urgent and emergency care services.”
Before the A&E redesignation takes place, Sir Bruce’s review said urgent care services outside hospital would be “enhanced” in order that people “no longer choose to queue in A&E”.
It said this would mean putting in place “same-day, every-day” access to primary care and community services and developing ambulances into a “mobile urgent treatment service” capable of treating more patients themselves instead of taking them to hospital.
Sir Bruce suggested up to 50% of 999 calls could be managed at the scene of the incident.
The design of the restructure follows the perceived success of a similar streamlining of services for stroke and trauma. The recent move to fewer specialist stroke and trauma units organised in networks has led to significantly improved survival rates, according to Sir Bruce.
Building on their success, the NHS will develop broader emergency care networks.
Sir Bruce also said the NHS 111 service would be enhanced, with access to medical records, the ability to book appointments with other services and greater access to speak directly to a nurse, doctor or other healthcare professional instead of a call-handler.
In addition, the NHS will provide better and more easily accessible information about self-treatment options so patients can avoid the need to see a healthcare professional if they prefer.
In a letter to health secretary Jeremy Hunt, Sir Bruce stated: “Our vision is simple. Firstly, for those people with urgent but non-life threatening needs we must provide highly responsive, effective and personalised services outside of hospital.
“Secondly, for those people with more serious or life threatening emergency needs we should ensure they are treated in centres with the very best expertise and facilities in order to maximise their chances of survival and a good recovery,” he wrote.
NHS England medical director Sir Bruce Keogh
Sir Bruce said he expected the system-wide transformation to take three to five years to complete but added that he wanted to see “significant progress over the next six months” in key areas.
A second phase of the review is now underway, which is looking at the delivery of the plans in more detail with around 20 stakeholder organisations.
Peter Carter, the Royal College of Nursing’s chief executive and general secretary, described the plans as “thoughtful and well overdue”.
He said: “If the report’s recommendations are taken up, it will go a long way to addressing the challenges facing the NHS. Providing better support for people to self-care would take pressure off the health care system and allow nurses to care for those most in need.”
He added that a “great deal more investment” was needed to boost community services.
“District nurses, for example, can prevent unnecessary hospital admissions and reduce the strain on emergency departments, yet there has been a 40% reduction in their numbers in the last decade,” he noted.
However, Unison head of health, Christina McAnea said the union “broadly welcomed the direction of travel” of the proposed shake up of A&E services.
But she argued that it “fails to address the fundamental problem facing the overwhelming majority – a basic lack of funding”.
“Staff are the key to tackling the problems currently dogging A&E services,” she said. “The fact remains that without a realistic funding settlement for the emergency services the pressures on A&E will only get worse.”
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