One in six A&E departments at risk of closure or downgrade

One in six A&E departments face being closed or downgraded in the next four years, according to an analysis of NHS proposals.

About 33 casualty departments in hospitals in 23 areas of the UK are facing either complete closure or being replaced with minor injuries units.

The plans are part of efforts to plug a £22bn hole in the health service budget by 2021. Health officials insist the changes will come alongside efforts to modernise services and increase specialist urgent care.

In seven cases, proposals have been drawn up, some of which have been issued for local consultation. According to research by the Health Service Journal (HSJ), 26 more hospitals are now considering plans to close or downgrade services but no final decision has been made.

The seven hospitals for which there are public proposals to downgrade or close emergency departments include Sandwell and West Birmingham hospitals trust’s City hospital and Sandwell district general hospital, which are due to be replaced by a new department at the Midland Metropolitan hospital that is scheduled to open in 2018.

The remaining 26 hospitals may have their A&Es downgraded or closed but, equally, they could be kept or upgraded. Decisions are expected to be made between either Shrewsbury or Telford, Bedford or Milton Keynes and Darlington memorial hospital or the University hospital of north Tees.

In total, about 24 of the 33 hospitals under discussion are likely to lose full A&E services, the HSJ said.

The news comes at a time when hospitals are under severe strain. Almost half of NHS trusts declared a major alert in January and record numbers of hospitals have diverted ambulances to other hospitals. The number of life-saving operations cancelled at the last minute has also reached a new high, with more than 4,000 put on hold last year.

An NHS spokesman said: “The number of people seeking urgent care is on the rise so overall we expect the range of services available to them to expand over coming years. Within that overall expansion, it may be possible to improve care and save lives with some concentration of specialist urgent services.”

He said he did not expect significant numbers of A&E changes in the years ahead, with one of the decisions – concerning Sandwell and City hospitals – taken some years ago.

Annual figures show the number of patients stuck on trolleys in A&E units for more than 12 hours has doubled in two years, with a tripling in cases among the elderly.

It has been claimed that one woman died of a heart attack after waiting for 35 hours on a trolley at Worcestershire royal hospital. The hospital’s A&E department has become overwhelmed so often that it has diverted ambulances to other units on 44 occasions since December. Yet the hospital is at the centre of plans by its trust to centralise A&E services and downgrade Alexandra hospital in Redditch.

The King’s Fund’s director of policy, Richard Murray, told the HSJ that the NHS appeared to be “caught betwixt and between”. The number of potential downgrades, he said, “is not high enough to conclude we are seeing a radical redrawing of urgent and emergency care, but it is high enough to suggest a lot of political noise and require a lot of potentially noisy public consultations”.

In November, the Labour leader, Jeremy Corbyn, who grew up in Shropshire, spoke out against plans to close either the emergency department in Shrewsbury or in Telford in what has become a bitter issue locally.

He said: “I want to make sure there are proper A&E facilities across Shropshire. I grew up in Newport and I remember the discussions about opening those A&E departments in the first place. There need to be A&E departments in reasonable reach of everyone’s homes so that, obviously, emergency cases can be dealt with quickly.”

Chris Moulton, vice-president of the Royal College of Emergency Medicine, told the Telegraph the plans were crazy. He said: “Hospitals are under massive pressure, it’s now horrendously common to have 12-hour trolley waits and in some cases 30-hour waits in A&E. The NHS has been desperately short of capacity for the last few years – it’s crazy to close A&E units when there simply isn’t capacity to cope with these patients elsewhere.”

Meanwhile, separate analysis by the BBC has found that the number of people facing longer waits than they should for hospital treatment in England has more than doubled since 2012.

A key target waiting time of 18 weeks is not being met for more than 350,000 patients, resulting in a 163% rise over four years, it was found. The total number of people on the waiting list is 3.7 million. Figures for Wales and Northern Ireland provided by the Royal College of Surgeons show they have also seen a rise.

One in six A&E departments at risk of closure or downgrade

Plan to "transform" NHS could lead to downgrade of major London hospitals

Council leaders have refused to sign up to a plan to “transform” NHS services amid fears two major London hospitals, Ealing and Charing Cross, are to be downgraded and will lose their A&E units and other acute services, the Guardian can reveal.

Plans being developed around England to tackle the NHS funding crisis involve increasing focus on “virtual” and outpatient care, and internal documents show there are plans in north-west London to close or downgrade its acute hospitals from nine to five.

Both west London hospitals are highly valued by local residents and have been the subject of campaigns to save them when they were threatened with closures in the past.

Leaders at both Ealing and Hammersmith & Fulham councils say they are determined that these hospitals should remain open with their A&E and operating surgeries and so have refused to sign up to the north-west London sustainability and transformation plan (STP), which is one of 44 such plans in development around England.

Critics of the plans fear that up to 500 acute beds could be lost if these hospitals are closed or downgraded.

The majority of the 44 plans – described by NHS England as internal documents – have not been published. The Guardian has seen two of the plans.

The STP for North-West London Collaboration of Clinical Commissioning Groups advocates:

• Reducing acute hospitals from the current nine in north-west London to five and reducing acute admissions by a third. The document says “… consolidate acute services onto five sites (the consolidation of acute services to fewer sites is not supported by the London boroughs of Ealing and Hammersmith & Fulham)”.

• The document also states that to replace the acute hospital closures there will be a “local hospital model” introduced. This has not yet been fully defined but is likely to be minor injuries/out of hours GP centres, rehab beds for elderly people after accidents, but no A&E, no medical or surgical beds, and no operating theatres.

• Making parts of the NHS “virtual” rather than using physical buildings for some consultations, and selling off some buildings that would become surplus to requirements as a result.

• Revolutionising the outpatient model by using technology to reduce face to face consultations by up to 40%.

• Give patients phone or face to face coaching to treat themselves.

Some of the proposals have support from experts and NHS professionals, as there are huge pressures on budgets as the UK copes with an ageing population.

However, the document says “unsurprisingly there are many risks to the achievement” of the ambitions in the plans.

Steve Cowan, leader of Hammersmith & Fulham council, told the Guardian that NHS officials were being forced to drive through the changes by the government.“We condemn the Tory government for drawing up these plans. This is about closing hospitals and getting capital receipts. It’s a cynical rehash of earlier plans and is about the breaking up and selling off of the NHS. It will lead to a loss of vital services and will put lives at risk.”

He added: “Our job is to protect the NHS and this plan is about dismantling it. This document is an affront to the sensibilities of the people of north-west London.”

Julian Bell, leader of Ealing council, said: “We refused to sign up to the STP plans because we do not support the closure of Ealing and Charing Cross acute hospitals … We have made it abundantly clear that we will campaign until our last breath to save Ealing and Charing Cross hospitals. We do support some of the proposals for more integrated health and social care but we feel we will be punished for not signing up to these plans.”

The document seen by the Guardian does not detail numbers of beds facing cuts in the two London hospitals. When asked why no numbers were specified for planned bed closures in the document, London North-West Healthcare NHS trust said: “The STP does not focus on beds because this ignores the fact that we are trying to deliver the best possible care for people, with no unnecessary delays or waits and with expanded services in the community to prevent avoidable admissions.”

The plan is regarded as one of the most detailed and comprehensive STPs produced so far and a strong indication of the government’s future plans for a radical transformation of the NHS.

NHS officials told the Guardian that any individual local council that chose not to engage with NHS partners would forgo the opportunity to join up social care and health services more effectively, but that would be their choice.

The risks highlighted in the plan include a failure to shift enough acute care out of hospitals, a possible collapse of the private care-home market and a failure to get people to take responsibility for their own health.

Council officials claim that pressure was exerted on them to sign off an executive summary of the draft plans quickly without seeing the full document. NHS officials have denied this.

The north-west London STP states that the demand for healthcare is projected to rise with an expected 53% increase in cancer cases by 2030 as well as an increase in conditions of old age such as dementia, yet the significant reduction in hospitals and acute beds is deemed the best way forward.

NHS England believes the STP process will bring many wider benefits including more joined-up care and that there is evidence to show care closer to home has advantages.

The pace of the planned changes is alarming critics. The north-west London plan states that changes need to be delivered “at scale and pace” in order to have a financially sustainable system by 2020.

John Lister, secretary of Keep the NHS Public, said: “The draft plan for north-west London really is a shocker. The assumptions they are making in this document are just enormous. No services anywhere will be safe with these plans. NHS managers are quite desperate when faced with massive and growing deficits, and are resorting to untested plans which will target the most vulnerable and the least mobile people.”

Plan to "transform" NHS could lead to downgrade of major London hospitals