Bruce Keogh proposes a two tiered emergency service for the NHS

The introduction of a two tiered emergency service would make clear the difference between smaller emergency centres and bigger major trauma units.  This proposition is part of a bigger review and reshuffle of the NHS’s emergency care services.  The change is needed because too many people go to A&E who don’t need emergency care.  4 in 10 leave A&E without  any treatments, and many others could easily have been looked after by their GP or at home.

The new two tiered service would mean smaller emergency centres could act as ‘triage’ for the trauma units: only transferring patients who need specialist treatment and equipment.  This reorganisation is trying to copy the success of having specialist centres of excellence which can then be provided with the resources and expertise to provide the highest quality of care for the critically ill patients.  This has been well demonstrated with stroke departments in London, with only 8 out of the 32 London hospitals having a specialist stroke department.

The report, produced by Keith Willett also outlined other ways to relieve stress from emergency departments such as making it easier for patients to speak to a health professional and making GPs more easily accessible to the public.  This will mainly be through an update of the current 111 NHS non-emergency phone line, to improve the service and to have healthcare professionals on call to help these patients.

Bruce Keogh, NHS England’s medical director emphasised that the introduction of a two tiered emergency service would take place over 3-5 years.  He also made clear that NHS England didn’t expect a cut in the number of emergency centres, but for the number to remain the same.  The proposal suggests that of the 140 A&E departments in England, between 40 and 70 will become major emergency centres.  The other 70-100 A&E departments could be seen to be downgraded to smaller emergency centres.  This new proposition hopes to use and build on existing emergency services which can be restructured to implement this two tiered emergency service.  This reorganisation alone won’t relieve all the pressure from A&E departments with a “growing and unsustainable pressure” building up on them.  A fundamental change is needed with clarity as to the future of accident and emergency departments and how they will face growing numbers of patients.


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