Published On: Fri, Jun 30th, 2017

Shutting down Emergency Units throughout the NHS

In the UK, accident and emergency units, or A&E departments, serve a vital purpose in the overall health care system for patients of all ages and experiencing the full range of medical conditions. As the initial gauge of the health of the UK population, A&E units are often the first line of defense against more severe health issues. Currently, there are three types of emergency departments available to the public: type 1, type 2 and type 3 units. In type 1 A&E departments, patients are seen for a variety of major health conditions and they have access to consultant-led services with full resuscitation facilities 24 hours per day. Type 2 units focus on a single specialty service, like dentistry or ophthalmology, while type 3 units offer walk-in services for minor injuries and illnesses. Each A&E unit type holds space in the NHS for a reason, but in recent months, sweeping changes to these services are on the docket.

Emergency Department of Edinburgh Royal Infirmary, opened 2003. photo/ Lisa Jarvis

In a recent announcement as part of the five-year forward plan for the NHS, 24 of the 175 A&E units around the country are scheduled for closure or downgrade to a lower level service provider. The intention is to reorganise emergency care services so that the total amount of spending is reduced across the NHS by shifting patients’ focus to seeking specialty and primary care instead of the hospital. Through a variety of sustainability and transformation plans that include downgrading and closing A&E units, medical care is being transitioned away from conventional measures and instead using care teams who have the ability to tend to patient needs in their home. These combined changes to accident and emergency care through the UK is meant to lower the budget of the NHS, ultimately promoting higher quality care through a more streamlined system. Although the changes to A&E units hold some promise, there are concerns that patients may suffer from longer wait times, greater lengths of travel to receive care, and fewer services once they arrive.

How Patients are Impacted

The NHS has been under pressure for the last several years to reduce its spending while simultaneously maintaining the quality of patient care UK residents receive. In an effort to accomplish both tasks, new targets were established as it relates to wait times in A&E units throughout the system. The four-hour target, while admirable, has been missed consistently for the majority of NHS trusts for more than a decade, meaning at least 5% of patients wait longer than this timeframe to either be admitted to a hospital or seen by a doctor. In fact, only four out of the 139 hospitals with type 1 A&E units have successful achieved the four-hour standard, and the closures and downgrades of A&E units across the board, some expect wait times to worsen.

Part of the issues surrounding extended wait times for patients and subsequent lower quality care is an ongoing staff shortage within the NHS coupled with a more demanding patient population. Although recruitment efforts have improved in the past few years, the extension of the operating hours imposed on the NHS, including A&E units, and lacking retention have made for a complex situation for patients. Adding to the issue is a rapidly aging population which requires more medical care than in years past, stretching the limits of capabilities within A&E units and the NHS overall. Instead of expanding services in the traditional sense, the five-year project implemented for the health care system seems to be shifting toward a reduced menu of services in certain regions. The strain placed on the A&E units that absorb the closing departments may prove too much, negatively impacting patient care well into the future.

A solicitor from an A&E negligence law firm shares these concerns, stating that the number of patients needing admissions to the hospital from an A&E department has steadily increased. When A&E units are closed and bed occupancy rates are already at an all-time high, patients do not have the luxury of being transferred to their next level of care in a timely fashion. The problems related to overcrowded A&E wait rooms and staffing shortages worsen if the closures and downgrades are not completed in a succinct, strategic way. Although there is promise in reigning in the budget of the NHS overall, patient well-being has the potential to suffer in the long run when fewer A&E type 1 units are available to the masses.

Correcting the issues within the UK’s health care system will take more than a single step toward reducing costs. The STPs as part of the five-year plan moving forward are designed to provide a healthcare system that is both less complex and more accessible to the growing number of patients seeking care, but the A&E unit closures are not alone the answer. Offering more services at patients’ homes, reducing wait times by having highly trained staff on hand, and encouraging healthier lifestyles for all UK residents are necessary components of a less strained system.

Author: Jose Calvo

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