Proposals to overhaul A&E services revealed by NHS chief

Lawrence McGinty

Former Science and Medical Editor

NHS Chief Medical Director Sir Bruce Keogh says A&E care needs to change. Credit: PA Wire

All A&Es are not equal - not any longer.

That is the phrase used by Sir Bruce Keogh as he introduced his blueprint for emergency care to journalists.

He wasn't saying that he was going to make them unequal - he was pointing out that was the reality of A&E care in hospitals today.

Some are better staffed, better equipped and more experienced than others. That's already been recognised as 25 A&Es have been designated as Major Trauma Centres.

Now Sir Bruce wants to formalise what everyone knows by designating between 40 and 70 of them as Major Emergency Centres. The others, between 70 and 100 of them, will be just Emergency Centres.

But he bit my head off when I asked him who would want to go to a "B-list" centre. There will be no second-rate centres he told me. Patients should expect good care in all of them. But the "super" centres will be able to do a range of more complicated and difficult treatments.

He then gave me his favourite example: In London, eight A&Es had been chosen to receive patients with heart attacks and strokes. By concentrating treatment in fewer centres survival figures had gone up by 20%.

But there is a third tier in Sir Bruce's blueprint. Over the years, 20 different kinds of treatment centres have been bolted on to the A&E system; walk-in centres, minor injuries units and so on.

Patients are confused - so they pitch up at A&Es. He wants to keep them but he wants to cut through the confusion by calling them all the same thing - probably urgent care centres.

He also wants to encourage people to treat themselves for really minor problems by making sure they get good advice - using pharmacists for example.

And he wants paramedics to have more training so they can treat patients without taking them to hospital. And he wants GPs to be given more "headroom" to provide more accessible services.

I think that means cutting the form-filling they have to do and perhaps employing more GPs (though he was careful not to commit himself to that in advance of another report he's currently writing on out of hours services).

This all adds up to quite a complicated system. How will patients find their way through it?

That's where the new improved 111 telephone system comes in.

It will be manned by doctors and nurses, not by call handlers relying on a computer programme.

And it won't just give you advice about your problem, it will book you am appointment in the place you need to be, whether that's your GPs, an urgent care centre or an emergency centre.

For all this to work properly one thing needs to happen: Doctors and nurses need to be able to get access to your medical records and to information like who usually looks after you at weekends?

Sir Bruce thinks the NHS is on the verge of achieving that. But it isn't there yet.

And that's the problem with Sir Bruce's vision. It makes sense. It hangs together. It could work.

But can the NHS make it work after spectacularly screwing up the introduction of 111 and equally spectacularly screwing up almost every computer system it's tried to make work.

In a phrase long forbidden by programme editors at ITV News, only time will tell.