- 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.
- Acute care
- BEDFORD HOSPITAL NHS TRUST
- BURTON HOSPITALS NHS FOUNDATION TRUST
- COUNTY DURHAM AND DARLINGTON NHS FOUNDATION TRUST
- Department of Health and Social Care (DHSC)
- Emergency care
- MILTON KEYNES HOSPITAL NHS FOUNDATION TRUST
- NHS England (Commissioning Board)
- NORTH TEES AND HARTLEPOOL NHS FOUNDATION TRUST
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Revealed: 24 A&Es could be closed or downgraded