The secret is out: not all A&Es are equal

Woman with finger to lips A&E services have been evolving for years

It has been an open secret in the NHS for years, it's just that nobody has been honest enough to tell patients. Until now.

In unveiling his new vision for urgent and emergency care, NHS medical director Prof Sir Bruce Keogh was upfront. "Not all A&Es are equal," he said.

In fact, you probably have to go back to the 1970s to find a time when all A&Es could offer the best treatment of the day.

Since then the advancement of medical science has meant specialist care has had to be focussed at fewer and fewer sites.

Take heart attacks, for example. Forty years ago patients were treated with bed rest and the hospital mortality rate was about 25%.

Over the years specialist units were set up and clot-busting drugs used.

Then in the 1990s it become clear the way forward was to mechanically unblock arteries.

Mortality rates have now been reduced to 5%.

But only about half of hospitals have the specialist equipment and doctors to provide the latest expert care.


Similar changes have happened in other areas from stroke services to trauma care.

One in five A&Es don't even have specialist children's services now.

It means the brand A&E has become almost meaningless.

Take Leeds and its surrounding areas stretching from Harrogate in the north to Barnsley in the south.

There are 10 hospitals with an A&E unit, all with varying degrees of expertise. By far the biggest and most important in the region is Leeds General Infirmary which deals with all the major trauma.

Comparing that to the unit at say, Dewsbury, is like comparing apples and pears. They are simply not the same.

And that is why splitting A&Es into two distinct groups - as Sir Bruce is proposing - makes a great deal of clinical sense.

But the problem now is the politics of it.

While in many areas the creation of a two-tier service has already happened in all but name, there are plenty of areas where it has not.

If and when that happens there will be a sense - rightly or wrongly - of some areas losing out.

As a result, making those decisions will become highly controversial, as Nigel Edwards, of the King's Fund think-tank acknowledges.

He says while the solutions are the right ones they will be "hard to sell" and "difficult to implement".

Nick Triggle Article written by Nick Triggle Nick Triggle Health correspondent

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  • rate this

    Comment number 104.

    Re 101. Prole. (Cont) Indeed, sorting "hospital flow" and in-patient capacity should be a priority for those in charge. Unfortunately it doesn't always appear to be. That's why I genuinely think yesterday's announcements were more about a "smokescreen" and spin than actually tackling the problems head on. There are some positives from yesterday but money and resources are needed - where are they?

  • rate this

    Comment number 103.

    Re 101.Prole. It is impossible to comment with certainty but it sounds as though there are / were no beds to admit your father in the main hospital directly to and the default is often to send the patient directly to A&E. The general lack of main hospital capacity and "bed blocking" are major contributory factors to A&E business. I sympathize but this is not the fault of the front line A&E staff.

  • rate this

    Comment number 102.

    Re: 100 Steerpike. It's unclear from your comment exactly what your working experience in the NHS is. Are you really an A+E consultant with 34 years front line experience? If so I find your views incredible. There are many front line doctors providing the best service they can under difficult circumstances. What exactly do you do? How much experience of treating seriously ill patients do you have?

  • rate this

    Comment number 101.

    @99. As a senior A&E doctor, can you explain to me, why, when both GP's and OOH's doctors have requested my father is admitted [to the Bradford Royal]. They simply refuse the GP's requests? And say he has to go to A&E instead?
    Happens time and time again. Could this be a reason why A&E is so busy? Because GP's and OOH MD's requests to admit sick patients are ignored?

  • rate this

    Comment number 100.

    Re: 99. D-Geggie

    I'll see your 20 years and raise you a further 14.
    I feel that its well past the time that doctors came out of their ivory towers and joined the real world.
    Yes, there are many working hard throughout the country attempting to provide the best service they can under difficult conditions. Unfortunately, few are doctors.


Comments 5 of 104


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