Review of emergency care in England is launched

BMJ 2013; 346 doi: (Published 18 January 2013) Cite this as: BMJ 2013;346:f392
  1. Jacqui Wise
  1. 1London

A major review of urgent and emergency services in England has been announced by the NHS Commissioning Board, to ensure consistency of standards of care across the country.

The review, led by the NHS’s medical director, Bruce Keogh, is likely to result in the closure of some emergency departments in favour of regional specialist units that provide high quality care for patients with heart attack, stroke, and trauma. However, the proposals will also need to maintain local access to services for less serious but urgent problems.

Keogh said, “Treatments for many common conditions such as heart attacks and strokes have evolved considerably over the last decade and are now best treated in specialist centres. Yet we know people want their A&E [accident and emergency department] nearby.”

He added: “This makes me think we need to review the increasingly complex and fragmented system of urgent and emergency care, so that sick, anxious, and often frightened people can get what they need when they need it.”

The review will define the different levels of emergency care, from specialist trauma centres at major hospitals to local facilities with nurses and GPs available to treat more routine but urgent health problems. The review will also examine the processes of transferring patients between these different levels of emergency care.

The NHS Commissioning Board emphasised that local commissioning would be at the heart of the review and that it would work closely with clinical commissioning groups to develop a national framework. The review’s terms of reference will be published shortly, and emerging principles will be published for consultation in the spring.

The review will also look at how to help patients go to the right place, so that those with the most serious illnesses and injuries can be seen more quickly. It will also look at how emergency care works with other NHS services, such as GP surgeries, community care, and the NHS 111 urgent advice telephone line. The review will examine seven day working to ensure that care is as good at the weekend as it is during the week.

Mike Farrar, chief executive of the NHS Confederation, which represents most NHS organisations, said that no change was not an option. “There is still a vital need for local urgent care services, but the development of a world class specialist emergency system capable of saving lives also requires having the right expertise, in the right place, at the right time.”


Cite this as: BMJ 2013;346:f392