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Quality of A&E services threatened by many STPs, research warns

Closing A&E departments can affect the performance of other units that remain within the same region, research warns.

The report, by the Centre for Health and Public the Interest, warns of the risks to patients if A&Es are closed as planned in many of the Sustainability and Transformation Plans (STPs) that are currently being implemented.

The research is based on experiences in North West London, where two Emergency Departments were closed in 2014.

Performance against the 95% 4-hour wait target dropped to as low as 60% shortly after the closures, meaning that up to 40% of patients requiring serious treatment had to wait over 4 hours to be assessed and admitted to an appropriate bed.

Since then the performance of North West London hospitals has been some of the worst in the country, sometimes managing to treat fewer than half of the patients within four hours. For time-sensitive conditions such as sepsis or respiratory failure such delays are life-threatening.

In addition, since the A&E closures in 2014 the bed occupancy rate in all hospital trusts in North West London has been above 85%, compromising clinical safety through overcrowding.

Across England, STPs are proposing to close or ‘downgrade’ up to 24 emergency departments.

STP footprints are not isolated, the report says. The STP for South West London, for example, also proposes to downgrade one of five A&Es, which will have a knock-on effect on North West London, and vice versa.

There has been a lack of equality impact assessment on the effects on deprived communities and the elderly in the NW London STP plan. Poverty is shifting from the centre of London to the outskirts, yet across London it is in these areas that clinical networks between a hospital, GPs and social care are being dismantled.

“Whilst isolated deaths due to pressures on the emergency system have been reported by the media, disinvestment in NHS and social care services has been explored in one recent study as a factor contributing to nearly 30,000 extra annual deaths in 2015.

Dr Gurjinder Singh Sandhu, the report author and consultant physician, said: “A pattern of rising mortality each year is emerging and we need further in-depth scrutiny of what caused this marked increase in mortality.

“Despite a dangerous deterioration in A&E performance since the closure of two local A&E Departments, the North West London STP still envisages closing a further two A&E units at some point in the future.

“Future planning needs to learn lessons from the reconfigurations that have already taken place and not continue with A&E closures based on assumptions which have not been borne out in reality.”

Read the full report here.

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