14. Emergency response

East Dorset Branch

(R) That RCN Congress declares that it will only support closures of emergency departments where there is a robust clinical case and not purely as a cost saving exercise

Result

The resolution was passed.

For: 99.57% (464)
Against: 0.43% (2)
Abstain: (3)

Debate report

Ally Mountjoy, from the RCN East Dorset Branch, asked Congress to declare that it will only support closures of emergency departments where there is a robust clinical case and where it is not purely a cost saving exercise.

As Ally outlined the pressures on emergency departments in the UK today, she described the additional risks patients now face as they spend more time travelling in ambulances. She said she wasn’t against centralisation but was against ad hoc closures based on financial pressures; closures must only be based on clinical grounds, with a rational and justified argument.

Delegates at Congress agreed, and many members used the closure of the accident and emergency department at Lewisham Hospital as their case study. Shirley Ali said this decision was an example of cost savings being put before clinical care.

John Hill urged members to take action, advising them not to wait to see their local accident and emergency departments closed down or downgraded, but instead speak to members of the local  Health Overview Panel now, to stop this from happening.

Michael Smith lamented the lack of meaningful consultation with local stakeholders that takes place when changes are proposed. He called for proposals to be piloted and questioned the cost of consultations which he said would be enough to run a department for two years.

Julian Newell, a long-standing emergency care nurse, said emergency departments need to be well-funded and supported. He called on the RCN professional and union representatives to work together on this issue. “United we stand a chance. Divided we may lose our NHS,” he said.

The resolution was passed with an overwhelming majority.

Background

The proposed closure of an emergency department can evoke a highly emotive response from politicians and the public alike. Emergency departments play an important role in stabilising acutely ill patients for transfer into the most effective care setting. It is important therefore that each case for closure is looked at based on the effect that it will have on the population it serves.

In January 2013 the England NHS Commissioning Board announced a review of urgent and emergency care services in England. In Scotland, stories of negative patient experience of emergency care pathways have re-emerged in the media. In Northern Ireland, patients face some of the longest A&E waits in the UK, while in Wales the reconfiguration of services continues.

In the midst of this UK-wide turbulence in urgent and emergency care consideration should be given to whether every instance of a proposed A&E department closure should be supported by a robust clinical case. For example, such a case may require the following elements:

• an assessment of the potential impact of the closure and subsequent re-configuration of local urgent and emergency care services on the outcomes of episodes of emergency care. This should include a formal risk assessment which takes into account the geography of the area within which the A&E operates, the other services available within that area and the services of neighbouring areas
• the ability of the provider in the area to continue to achieve local and relevant national quality indicators for specific emergency pathways including but not limited to head injury, stroke and cardiac care
• an equality impact assessment which examines the impact of the closure on the population in terms of their age, sex, socioeconomic status, place of residence, religion, race and any other factor required by local and national legislation.

There will inevitably be geographical variations across the UK so it is important to maintain equity of access across the four countries.

Where an A&E department is to be closed the capacity for delivering alternative services must be considered. In some cases the closure of an A&E may be supported by a robust clinical case, such as the establishment of a major trauma network. In these instances it is vital that the capacity originally available locally is maintained with an equivalent 24 hour urgent care service and that the local population can expect the same or better outcome in the event of major trauma.

In all cases the consideration of A&E closures should be owned by those most knowledgeable in emergency care – health care professionals – and involve those most knowledgeable about local issues – the public.
 

References and further reading

Department of Health (2013) Accident and Emergency London:DoH. Available at: www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/AccidentandEmergency/index.htm (accessed 22/03/13) (Web).