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The A&E debate

26th October 2006

The prediction by David Nicholson that A&E services in up to 60 hospitals could be axed as part of the continuing NHS reforms has stirred mixed feelings within the healthcare community. The national driver for acute reconfigurations stems from the government's white paper Our Health, Our Care, Our Say but changes will need to be consulted and agreed at a local level. It should not be assumed that everyone is against the closures; a recent NHS Confederation report argues that A&E departments are increasingly being used for chronic disease management and many senior nurses consider that changes "are long overdue". One estimate puts the number of attendances requiring a fully staffed and equipped trauma centre at 1%; the remaining 99% could be treated in a nurse-led minor injuries unit or by an emergency care practitioner. But other A&E nurses believe that the agenda is all about cost cutting. The drive towards community care is not necessarily right for all patients and those that do attend A&E inappropriately usually do so because they are being failed by primary care. Research has shown that when an A&E closes, "a third go to another A&E, a third go to primary care but a third just disappear". Whatever changes happen, proper evaluation is required at a local level; nurses may have one opinion but the public opinion will be even stronger.

Craig Kenny, Nursing Times

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