Is there a plan to cut care at A&E departments?

As concern builds over whether England's A&E departments will survive the busy winter period, a new report into emergency care makes the case that hospitals operating beyond their capacity is no longer a seasonal phenomenon. That a patient is more likely to face a long wait in December is not an isolated issue, but a symptom of a system struggling to cope.

In his report Sir Bruce Keogh, the National Medical Director of the NHS, outlines a series of "essential" reforms designed to diffuse the "intense, growing and unsustainable pressure" on A&E. Today the media seized upon his main initiative - to designate some A&Es as Emergency Centres and others as Major Emergency Centres.

The front page of today's Daily Telegraph reported this as, "Two-tier A&E as 100 units cut care". However, the report is clear that this is not what's being suggested:

"These proposals are not about cutting existing urgent and emergency care services." [emphasis in original]

The Department of Health's director of communications was among those who criticised the newspaper's interpretation of the report:

In fact the main body of the Daily Telegraph's article actually contradicts its headline, quoting a spokesperson for NHS England as saying that Sir Bruce's report "specifically rejected the idea that there would be cuts in accident and emergency departments".

Sir Bruce's argument is that there's currently no consistency in A&E provision - although the public trust in the "red and white sign", many A&Es lack the staff and the facilities to treat complex cases. He claims that the public would be better served by the NHS developing 40-70 A&Es as specialist centres for major emergencies and allowing the remainder of casualty units (approximately 100) to concentrate on more minor injuries. However, he expects the overall number of A&Es to remain "broadly equal" to today's total.

The report notes that this approach has already been successful with reducing the number of deaths from stroke, where patients do not necessarily end up at their nearest hospital but are instead transported to a regional stroke unit.

NHS England has argued that reform involves the upgrading of certain A&E departments. The Daily Telegraph has chosen to look at this from the opposite angle - that if certain A&Es are being expanded and improved, this is likely to involve others losing services. It's not yet clear how these ordinary Emergency Centres will be redesigned. For this level of detail, we must wait for Sir Bruce's follow-up review.

However, there's no evidence in today's report for the Daily Telegraph's claim of a "cut" in services, and its author states emphatically that this is exactly not what he's proposing.