How would you organise A&E if you had the responsibility? Well if someone has an accident or an emergency then it is really important to make sure you provide a good service and to make sure that your service is not too far from the people who have the accidents and the emergencies. However today's Sunday Politics in the North West considered the loss of Burnley's A&E as a possible template for other towns.
Accidents can range from minor injuries (and some towns have lost their A&E to a minor injuries unit and some to nothing at all) to life-threatening injuries. Similarly emergencies can range from those that need reassurance only (some would describe them as trivial but I'm sure they are not if you are the person who needs the reassurance) to an acute exacerbation of a chronic disease which again may be life-threatening.
Whether you choose to amalgamate A&Es will depend on costs. You will justify the costs of staffing in most towns because members of the public will come through the doors. Whether those people can be treated satisfactorily will colour your view. There will be many conditions which are treatable within a normal department. Reassurance can be given, stitches can be sewn and tablets can be prescribed. As for the life-threatening conditions then highly specialised resources will be needed as they are now which may or may not be associated with the casualty unit.
The Duke of Edinburgh recently fell ill at Sandringham and had to pass a couple of general hospitals to get to Cambridge where a specialist service was available. Centres of excellence will always have a place. However A&E provides an essential service which is commonly needed, and on that basis should be provided as close as possible to populated areas. In short, we should be keeping A&Es open.
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