• Twenty four emergency departments - around 15 per cent of the national total - could be closed or downgraded in the next four years, analysis shows
  • HSJ has identified and mapped those most likely to be affected in an unprecedented analysis

Twenty four emergency departments - around 15 per cent of the national total - could be closed or downgraded in the next four years, according to HSJ analysis.

HSJ has identified which of the NHS’s circa 175 Type 1 adult emergency departments are at risk of downgrade or closure by 2020-21 based on existing NHS proposals, including sustainability and transformation plans, and other intelligence.

Thirty-three hospitals across 23 areas have an emergency department which may be closed or downgraded in this parliament, it found. Of these, there are seven EDs which have agreed and public plans for the change. Three of the seven, the plans of which have already been mde public, will close completely.

Across a further 17 areas, there are 26 hospitals which are in contention for downgrade, but where no final decision has been made. The downgrade of one would lead to the retention of one of the others, meaning 17 of these EDs in total could be  downgraded, giving a total of 24 in both categories.

Senior medics and policy experts said this number of downgrades and closures in the next few years would cause political controversy – but that it did not match the level of radical change envisaged in NHS England’s flagship urgent and emergency care review published in 2013 (see Analysis: Sweeping A&E overhaul has not materialised).

The seven hospitals for which there are clear, public, proposals for downgrade or closure include the planned closures of Sandwell and West Birmingham Hospitals Trust’s City Hospital and Sandwell District General Hospital EDs, which are due to be replaced by a new department at the Midland Metropolitan Hospital scheduled to open in 2018. These are classified as “red” (see map and list below).

The remaining 26 hospitals involved in plans which could see their EDs downgraded or closed, but equally could be kept or upgraded, have been rated “amber”.

Examples of this include the decision between EDs in Shrewsbury and Telford; Bedford and Milton Keynes; and between Darlington Memorial hospital and the University Hospital of North Tees.

There are a number of other hospitals where campaigners or unions have raised concerns about the future of their ED, but where we have not judged that a downgrade/closure is likely. This is because of factors such as a lack of firm proposals and practical and political barriers. Trusts in this category include a number of small trusts like the Princess Alexandra in Harlow, which appears unsustainable in its current form but where downgrading its A&E is not under formal consideration.

NHS England and the Department of Health have been approached for comment.

In full: A&Es most likely to face downgrade or closure
Note: reasons for the rating and the trust’s responses are included in the map above.

Alexandra Hospital, Redditch Worcestershire Acute Hospitals Trust Red
Dewsbury and District Hospital Mid Yorkshire Hospitals NHS Trust Red
Ealing Hospital London North West Healthcare NHS Trust Red
King George Hospital Barking Havering & Redbridge Univ Hosps NHS Trust Red
Poole Hospital Poole Hospital NHS Foundation Trust Red
City Hospital Sandwell and West Birmingham Hospitals Trust Red
Sandwell District General Hospital Sandwell and West Birmingham Hospitals Trust Red
Scarborough General Hospital York Teaching Hospitals FT Amber
Horton General Hospital Oxford University Hospitals NHS Foundation Trust Amber
Huddersfield Royal Infirmary Calderdale and Huddersfield NHS Foundation Trust Amber
Macclesfield District General Hospital East Cheshire NHS Trust Amber
Bedford Hospital Bedford Hospital NHS Trust Amber
Milton Keynes University Hospital Milton Keynes University Hospital NHSFT Amber
Darlington Memorial County Durham & Darlington NHS Foundation Trust Amber
Epsom Hospital Epsom and St Helier University Hospitals NHS Trust Amber
Kingston Hospital Kingston Hospital NHS Foundation Trust Amber
St Helier Hospital Epsom and St Helier University Hospitals NHS Trust Amber
University Hospital Of North Tees North Tees and Hartlepool NHS Foundation Trust Amber
Queen’s Hospital Burton Hospitals NHS Foundation Trust Amber
Southport and Formby District General Hospital Southport and Ormskirk Hospital FT Amber
Broomfield Hospital Mid Essex Hospital Services NHS Trust Amber
Southend University Hospital Southend University Hospital NHS Foundation Trust Amber
Charing Cross Hospital Imperial College Healthcare NHS Trust Amber
Chorley and South Ribble Hospital Lancashire Teaching Hospitals NHS Foundation Trust Amber
The County Hospital University Hospitals North Midlands Trust Amber
Grantham & District Hospital United Lincolnshire Hospitals NHS Trust Amber
Royal Shrewsbury Hospital Shrewsbury and Telford Hospital NHS Trust Amber
The Princess Royal Hospital Shrewsbury and Telford Hospital NHS Trust Amber
Warrington Hospital Warrington & Halton Hospitals NHS Foundation Trust Amber
George Eliot Hospital George Eliot Hospital NHS Trust Amber
Weston General Hospital Weston Area Health NHS Trust Amber
Tameside General Hospital Tameside Hospital NHS Foundation Trust Amber
Fairfield General Hospital Pennine Acute Hospitals NHS Trust Amber


Methodology and definitions

  • HSJ has only looked at adult Type 1 emergency departments. These are defined by NHS England as: “A consultant led 24 hour service with full resuscitation facilities and designated accommodation for the reception of accident and emergency patients.” We have not looked at children’s hospitals which also see Type 1 admissions.
  • Red rated: A downgrade or closure has been publicly proposed and agreed.
  • Amber rated: Plans and/or other intelligence suggest the ED will potentially be downgraded or closed by 2020-21, but no firm public proposal has been made.
  • All trusts rated either red or amber were asked for a response – where given, these are included in the map.


Revealed: 24 A&Es could be closed or downgraded