Accident and emergency departments are the front line of acute care, and are effectively the NHS's shop window. But in too many places they still resemble the service as it was in a bygone era. Physically, they have failed to keep pace with the changes taking place around them - in society at large as well as elsewhere in the NHS. Many are in poor shape to deliver modern emergency medical and nursing care. Patients - increasingly demanding and critical, occasionally violent - are well aware of this, while staff struggling to achieve best practice in shabby surroundings provide a vivid image for television drama and documentary makers.
Little wonder, then, that for this image-conscious government it is the A&E department, out of a host of deserving cases in the average district general hospital, which is the priority for a Budget cash boost. But whatever the motivation,£100m in the next 12 months should make a noticeable and lasting difference to life on the front line. Admission wards, observation units and special areas for children should be taken for granted in any modern A&E department; hopefully, they soon will be in the NHS.
But A&E is frequently used as an alternative to primary care, especially in inner cities - a costly trend which refurbishment might reinforce. The Department of Health appears to have anticipated this, by complementing its A&E investment with£30m 'to develop direct access to the NHS'.
Some measures will certainly be needed, but it is open to question whether the favourites for attention are the most promising. NHS Direct has made an encouraging start, but aspirations for it are in danger of swelling out of proportion. And locating GPs in high street shops is a novel idea which has been around since the days of Stephen Dorrell - but little analysis of its implications ever accompanies its perennial appearances.
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