On the day the NHS qualifies for its pension, here's news that A&E coverage in London could be radically changed under new proposals from the NHS.
Rules covering the minimum amount of time consultants spend with patients are planned for the next couple of years, to help shift the problem of 'backlogs' building up over weekends and overnight. These happen when patients are waiting to be assessed by senior doctors who aren't available out of hours. It's a sensible idea, particularly with the current overburdening of A&E units. But the knock-on effect is likely to infuriate Londoners: smaller hospitals that can't meet the standards will have their funding for emergency care cut, and will either be transformed into Urgent Care Centres or not take emergency cases overnight.
The plan is based on the idea (backed up with evidence for stroke, cardiac, trauma and vascular illnesses) that larger units with more and specialised staff give better care. The Danes have been running a similar system and report shorter hospital stays, no increased mortality rates and lower readmissions.
However, the system proposed for London is likely to confuse your non-blue light patient. Check your watch: is your local A&E an A&E at the time you need it? We feel a little bit the way we did when the final plans for Lewisham Hospital were announced, to create an A&E that doesn't deal with all emergencies. How are we supposed to work out where's the best place to go?
Oh, and speaking of Lewisham, it's one of the hospitals that would first in the firing line under the minimum-consultants plan as it fares particularly badly in the report stats (PDF), despite mortality being lower than the national average. So, even if campaigners win the current High Court appeal, the hospital could be downgraded by the back door, along with units at St Helier and Whittington, which have already felt the threat of the axe. How convenient.
The Standard asked London regional director Dr Anne Rainsberry about potential closures, and she offered an eyebrow raising reply:
We are not closing anything. What we are doing is providing different services at different sites... Legally we can’t move a service without consulting on it, but legally there is a lot hospitals can do to meet these standards.
In other words: shape up, or we'll close you down – sorry, move services somewhere else – on grounds of safety.