Here's what he first said on the Acton forum:-Per usual, there can't really be any reasoned debate on these proposals due to the overwhelmingly inflammatory nature of the comments that are typically made.There are a couple of things to take into account when considering these proposals:1. Firstly we need to differentiate between emergency care and urgent care. The two are quite different and require different skillsets and resource levels.2. We also need to recognise the tremendous innovation that has taken place in the ambulance service - patients in critical condition can now be stabilised and transferred to specialist centres in ways that simply weren't possible 40 years ago when much of the NHS infrastructure was developed. The recent change to stroke care in London (all potential cases now go by ambulance, are treated on route and get taken to specialist centres), has resulted in less cost, more lives saved, and critically, more patients treated in time to avoid the need for major rehabilitation.3. Having considered the evidence that clinical outcomes won't be compromised by patients travelling longer distances, we can then look at cost. Too much of the NHS budget is tied up maintaining huge buildings in secondary care - this needs to be released to fund urgent improvements in primary care that would in many cases reduce the burden on hospitals in the first place e.g. managing patients with chronic conditions more intensively in community settings and thus avoiding expensive unscheduled admissions through A&E. To put this into perspective, centralising some elements of A&E has the potential to release tens of millions in annual funding, all of which will be retained in Primary care.4. The issue of records is a red herring - in genuine emergency cases, it's very often the case that decisions are made with very little reference to records. Even at Ealing Hospital, frequent attendees of A&E benefit little from the proximity to local GPs since their records aren't available to the hospital doctors or vice versa.5. It's quite wearing to constantly read about "fat cats" by people who typically have no understanding of the level of complexity that managing an organisation of 5000+ staff brings with it. In the case of Ealing, many of their medical staff earn substantially more than the current CEO (two to three times more in fact). Tie that together with the 5.7% reduction in the number of NHS Managers over the last year and the whole argument is bogus, not least as the NHS has far fewer managers than other organisations of similar size / complexity.6. Finally, let's deal with travel time. Most of the country have to travel more than 15 minutes to get to A&E and a comparison of health outcomes for both emergency medicine and urgent care shows there that the link between distance / time and outcomes is exaggerated, often to suit the vested interests of the loudest voices. We need to grow up a bit and really decide whether we want short journey times and higher death rates, or longer journey times and lower death rates as that's really the choice on offer - concentrating specialist skillsets, diagnostics and infrastructure on the scale that A&E demands is simply not feasible in the current district general hospital model. Personally I'm more interested in staying alive if I'm ever unfortunate enough to need emergency treatment and to that end I strongly support the proposals.
Chris Veasey ● 5060d