Hospital Downgrades ‘Could Kill Thousands’

Thousands of patients could die as a result of Labour’s policy to downgrade accident and emergency departments, research shows today.

{mosimage}A study has found that the further patients travel in an ambulance to reach hospital the more likely they are to die.

Its authors say the findings show Government policy-making “may be driven by anecdote or supposition” rather than based on evidence of what is best for patients.

The policy of providing community-based services and downgrading A&E departments, which was outlined in a White Paper in January 2006, has provoked protests.

Many fear it will mean they have to travel further for emergency care and say it is simply a cost-cutting measure.

Yesterday, David Cameron said the policy would lead to the closure of 29 hospitals.

He said people could not understand why A&E departments were closing when admissions were up and promised to fight to save units.

His attack comes amid other damning developments in health services. A report ranked England among the worst in Europe for cancer survival rates, research in the British Medical Journal showed that junior doctors were not receiving the training they needed to provide high quality care in the future and thousands of nurses faced unemployment due to a lack of jobs.

The A&E research is published in today’s Emergency Medicine Journal and says that mortality rates increase by one per cent for every extra 10km travelled.

The report was drawn up by a team from Sheffield University who studied more than 10,000 emergency calls to ambulance services in Berkshire, Derbyshire, Essex and West Midlands between 1997 and 2001.

Increasingly, patients with burns, suffering a heart attack or those with multiple traumatic injuries bypassed their nearest A&E to go to a specialist centre rather than being stabilised at a local hospital and then moved on.

The research paper said for some patients such as those with severe allergic reactions, choking, drowning or respiratory problems it was safer to go to the nearest hospital as the care was the same there as in a regional centre.

Those with chest pain may benefit from a longer journey if they went to a specialist unit.

The report by Prof Jon Nicholl and others concluded: “Our data suggest that any changes that increase journey distances to hospital for all emergency patients may lead to an increase in mortality for a small number of patients with life-threatening medical emergencies, unless care is improved as a result of the reorganisation.

“However, even then it is not certain that it would be acceptable to trade an increased risk for some groups of patients, such as those with severe respiratory compromise, for a reduced risk in other groups such as those with heart attacks.”

Other analysts have said that politicians should not decide the exact location of hospital services and should instead leave it to local clinicians and patients.

Andrew Lansley, the shadow health secretary, said: “This is exactly the kind of evidence we need to determine access to A&E services. The need to concentrate specialised services in some hospitals should not preclude access to local A&E services but the Government is using it as an excuse to close them down.”

Experts have warned that small hospitals cannot provide round the clock care safely and some services must be concentrated into larger units.

A spokesman for the Department of Health said that the study was already out of date as it analysed emergency calls made more than six years ago and so did not take into account recent improvements to ambulance services that meant paramedics could now start treatment before reaching hospital.

She said: “The aim should always be to provide high-quality care close to home where this is clinically safe, but some patients may require more immediate specialised care at centres with clinicians who have the right expertise and equipment.”