'Two-tier A&E' reforms announced

"Plan for two-tier A&E as part of radical shake-up," was today's BBC News headline, reflecting the sentiment across the UK media.

The headline comes in response to a new report written by NHS medical director Professor Sir Bruce Keogh, entitled "Transforming urgent and emergency care services in England" (PDF, 1.19Mb).

Professor Keogh's report sets out numerous proposals, including a new service configuration for accident and emergency (A&E) services in the UK. The report describes current A&E services as "under intense, growing and unsustainable pressure" and in urgent need of change.

Among the proposals is the recommendation to form a new "two-tiered emergency service", which, the report argues, is a better use of resources than the current set-up.

How would two tiers of A&E work?

The two-tier A&E proposed in the report would see the most serious emergency patients sent to highly specialised hospitals called "major emergency centres", which would have a concentration of expertise in one place to provide the best available care. The major emergency centres would be capable of not only assessing and initiating treatment for all patients, but also providing a range of highly specialist services using specialised equipment.


Less serious cases, that were still considered emergencies, would be treated in standard "emergency centres". These will be capable of assessing and initiating treatment for all patients and safely transferring them when necessary.

The proposed shift aims to stop existing A&E departments trying to do everything, which the report says has led to inconsistencies in treatment across the country. The report argues that it is better for some hospitals to specialise and concentrate their resources to cater for the most serious cases - such as heart attacks, strokes and major trauma - and for less serious cases to be treated in a different type of hospital.

To some extent this has already happened, so part of the new approach is to make it clearer where the best and concentrated services are and how they can be used more effectively. The report says that this would also dispel the false belief of many patients that all A&E departments provide a similar service and are equally equipped to treat a range of illnesses. They are not - there is much variation across the country according to the report. As BBC News puts it: "The secret is out: not all A&Es are equal."


Who is calling for the shake-up of A&E?

The calls for the shake-up are being led by the NHS medical director, Professor Sir Bruce Keogh, a former heart surgeon who led the review published today on behalf of NHS England. The review was in response to concerns that, in his own words: "A&E is creaking at the seams. It is not broken, but it is struggling." He is also quoted by the BBC as saying: "We need to change the way we work. But what we are suggesting here already exists in places, we are just trying to formalise it so it is available for everyone."

Professor Keogh's review looked into how the NHS organises and provides its urgent and emergency services in England to see what improvements could be made.


"Two-tier plan to solve A&E service crisis," The Guardian reports. The NHS medical director, Professor Sir Bruce Keogh, has recommended that specialist services, such as trauma services, are centralised in "major emergency centres".

Links to Headlines

NHS plan to concentrate specialist A&E expertise in fewer hospitals. The Guardian, November 13 2013

Cure for A&E crisis... or just another sticking plaster? Two-tier casualty units to speed up care and 111 service gets more doctors in shake-up of health care. Daily Mail, November 13 2013

Two-tier A&E as 100 units cut care. The Daily Telegraph. November 13 2013

Top doctor calls for two-tier A&E to relieve casualty wards 'creaking at the seams'. The Independent, November 13 2013

Plan for two-tier A&E as part of radical shake-up. BBC News, November 13 2013

A&E Services: NHS Plans Two-Tier Service. Sky News, November 13 2013

Paramedics will treat more people at home to help ease A&E crisis, new NHS report reveals. Daily Mirror, November 13 2013

NHS revolution will keep urgent cases out of A&E. Metro, November 13 2013

Useful Links

Further Readings

NHS England. Transforming urgent and emergency care services in England: Urgent and Emergency Care Review: End of Phase 1 Report (PDF, 1.19Mb). November 2013

Article's categories
Medical practice
QA articles
Article Review/Published Date
2013-11-13 10:45:00Z
Emergency and urgent care,Tremor
Credits Section
Analysis by Bazian
Edited by the NHS website