PRESS RELEASE
May 21, 2007

Malcolm Moss MP expresses concern over the threat of A&E hospital cuts in North East Cambridgeshire

A&E must have catchment areas of half a million people suggests report

 

Malcolm Moss MP expressed grave concern today at reports that the 92 of England’s 204 Accident and Emergency departments could be axed – if Labour press ahead with plans to force A&Es to serve an area covering at least 450,000 people.

Currently A&Es in the East of England serve an area of 291 665 people, but NHS organisations are pressing ahead with plans to close down A&Es, saying that they have been instructed to by the Department of Health.  If A&Es are forced to serve 450,000 people, this would mean cuts of 7 A&Es in the East of England region; from 19 to a mere 12. The plans also fly fly in the face of recommendations by clinicians.

Malcolm Moss MP said:

“Access to Accident & Emergency services is a vital component of the quality of NHS services. There is no clinical evidence which would justify shutting down A&E departments simply because they don’t serve a catchment population in excess of 450,000. Yet Whitehall bureaucrats are seeking now to justify closures on these grounds.

“Such closures are being driven by financial deficits – thanks to Gordon Brown, who has been controlling the NHS purse-strings. These latest Labour cuts to our NHS must be resisted, yet I fear the Gordon Brown – as Prime Minister – is merely going to offer more of the same.”

Notes to Editors

CURRENT NUMBER OF A&Es

There are currently 204 major (sometimes referred to as ‘type 1’) Accident and Emergency (A&E) departments in England, serving a total population of 50 million people. On average, each A&E department serves a population of 247,214.

	Number of major Accident and Emergency departments	Population	Catchment population of each A&E
North East	14	2,558,308	182,736
North West	33	6,846,249	207,462
Yorkshire and the Humber	21	5,063,944	241,140
East Midlands	12	4,306,335	358,861
West Midlands	23	5,365,438	233,280
East of England	19	5,541,636	291,665
London	32	7,517,726	234,929
South East Coast	16	4,213,904	263,369
South Central	12	3,950,320	329,193
South West	22	5,067,794	230,354
England	204	50,431,654	247,214

The catchment populations of A&E departments in each of the NHS’s Strategic Health Authority (SHA) areas varies widely. In the North East for example, an average A&E department serves just over 180,000 people, while in the East Midlands an average A&E department serves almost 360,000 people.

CUTS ON WAY: NEW DEPARTMENT OF HEALTH GUIDANCE

The Department of Health has apparently ordered the NHS to design Accident and Emergency services so that each major A&E department serves a population of at least 450,000 people, but only in London and the South East. The guidance has been referred to in strategy documents prepared by local NHS organisations, and by the Department of Health’s director for emergency care.

A document prepared by the West Surrey NHS confirms that (West Surrey NHS, Clinical options workshops, March 2007; http://www.conservatives.com/pdf/AEcuts.pdf)

“Current Department of Health and Strategic Health Authority guidance suggests that to be viable in terms of patient need, patient safety, staffing numbers and clinical training requirements, a full A&E department in the future would need to be supported by a catchment population of between 450,000 and 500,000 people.”

A staff briefing by the Surrey Primary Care Trust in March 2007 similarly confirms that:

“National guidance – full A&Es to serve a catchment population of 450,000-500,000 people.”

Source: Surrey Primary Care Trust, Creating an NHS fit for the future: staff briefing, March 2007; available at: http://www.transition.surreypct.nhs.uk/fit-for-the-future-briefings/Fit_for_the_Future_Staff_briefingsMarch_2007.ppt.

IMPACT OF NEW GUIDANCE

If the guidance which insists that each A&E department serves a minimum of 450,000 people is implemented, then the number of A&Es required in each SHA area is listed below:

The North West will require only 15 A&E departments, rather than the 33 it currently has – suggesting that 18 will need to be closed or downgraded.

London will require only 17 A&E departments, rather than the 32 it currently has – a decline of 15.

The South West will require only 11 A&E departments, rather than the 22 it currently has – a decline of 11.

The West Midlands will require only 12 A&E departments, rather than the 23 it currently has – a decline of 11.

Yorkshire and the Humber will require only 11 A&E departments, rather than the 21 it currently has – a decline of 10.

The North East will require only 6 A&E departments, rather than the 14 it currently has – a decline of 8.

The East of England will require only 12 A&E departments, rather than the 19 it currently has – a decline of 7.

The South East will require only 9 A&E departments, rather than the 16 it currently has – a decline of 7.

The South Central region will require only 9 A&E departments, rather than the 12 it currently has – a decline of 3.

The East Midlands will require only 10 A&E departments, rather than the 12 it currently has – a decline of 2.

Overall, the total number of A&E departments in England will fall from 204 to 112 – a decline of 92.

The calculation is achieved through dividing through the population of each SHA area with the catchment populations which the Government wants each A&E to serve – 450,000. This is spelt out in the table below:

	Population	Forecast number of major Accident and Emergency departments if each serves 450,000 people	A&Es downgraded or closed
North East	2,558,308	6	8
North West	6,846,249	15	18
Yorkshire and the Humber	5,063,944	11	10
East Midlands	4,306,335	10	2
West Midlands	5,365,438	12	11
East of England	5,541,636	12	7
London	7,517,726	17	15
South East Coast	4,213,904	9	7
South Central	3,950,320	9	3
South West	5,067,794	11	11
England	50,431,654	112	92

NO HEALTH GROUNDS TO SUPPORT CUTS

The figure of 450,000 appears to have been plucked out of thin air, and is not the minimum recommended catchment population made by leading clinicians:

In March 2006, the Royal College of Surgeons of England published Delivering High-quality Surgical Services for the Future, which recommended a minimum catchment population of 300,000. It said that:

“The majority of acute hospitals currently have, and are likely to continue to have, a catchment population of approximately 300,000. Some rural hospitals do not reach even this population mass, and yet are still required to provide as full a range of services as possible…There needs to be, in the first instance, strategically planned reorganisation so that, where feasible, smaller hospitals are able to merge to achieve a catchment population of at least 300,000.”

Source: Royal College of Surgeons of England, Delivering High-quality Surgical Services for the Future, March 2006; available at: http://www.rcseng.ac.uk/rcseng/content/publications/docs/reconfig.html.

Other leading clinicians decide not to define a sustainable Accident and Emergency department with reference to a hospital’s catchment area, at all – but rightly use the number of actual attendances to define demands on a hospital. The British Association for Emergency Medicine and The College for Emergency Medicine, for example, demand that:

Hospitals with attendances at A&E in excess of 40,000 per year should have, “immediate access to the key supporting specialties to allow an emergency department to function safely. The following should be available on site: intensive care, anaesthetics, acute medicine, general surgery, orthopaedic trauma. There should be rapid easy access to child health (preferable on-site), 24-hour access to imaging (including CT scanning) and laboratory services available on-site”.

Even those hospitals with fewer than 40,000 attendances at A&E per year should continue to retain A&E services, provided that, “they are able to demonstrate their effectiveness, safety and quality”.

Source: British Association for Emergency Medicine and The College for Emergency Medicine, Way Ahead 2005, 2005; available at: http://www.emergencymed.org.uk/temp/1337-pubs_way_ahead_2005.pdf.