Health reforms close 88 casualty units

HOSPITAL managers have shut down casualty units at a rate ofmore than one a month under sweeping health reforms. The changes, which have taken place in the past six years, mean that each hospital with an accident and emergency unit (A&E) must, on average, serve an extra 75,000 people.

The Department of Health disclosed this weekend that the number of NHS trust and directly managed hospitals with A&Es in England had fallen from 301 in 1988 to 213. Health authorities and trust managers have closed and merged departments in an attempt to concentrate care on fewer sites. A&Es are then 'shared' by several hospitals in the same area.

Medical experts and health service managers said the reforms, based on the findings of a 1988 report by the RoyalCollege of Surgeons, improved the treatment of accident and emergency victims by developing specialist expertise.

However, plans to close and merge A&Es have met with protests from residents, local politicians and unions. They said that the closing an A&E in one area left thousands of people without reasonable access to treatment.

Labour has criticised the trend. David Blunkett, the shadow health secretary, said yesterday: 'The decline in accident and emergency provision is continuing at an alarming rate. The loss of casualty units without any clear evidence that appropriate alternatives are in place is very worrying.'

Dr Keith Little, president of the British Association of Accident and Emergency Medicine, which is in favour of the increased specialisation, said: 'It tends to happen in centres of population where there are several or multiple A&Es which are geographically close.

'There is a finite budget, so if you have three departments which are close together, your resources are split three ways. If you amalgamate those departments on one site, you have three times the staff. Also, staff become more adept in the treatment of major trauma.'

The 30 per cent fall in the number of hospitals with A&Es since the RCS report has increased the average population each must serve by 50 per cent, from 150,000 per hospital to 225,000. The largest single yearly decline was between 1991-92, when the number of sites with casualty units fell by 56.

Closures and mergers have been met with stiff opposition. Next month, Sheffield Health Authority will consider proposals which could lead to the city's Royal Hallamshire Hospital losing its unit. Staff and facilities would be transferred to the Northern General. Opponents said the city, with 450,000 residents, should have two A&Es. More than 100,000 signatures have been collected for a petition of protest.

In Liverpool, more than 200,000 people have signalled their opposition to the closure of Broadgreen Hospital's A&E in two years' time.

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