National emergency access director Professor Sir George Alberti has backed controversial proposals to shut a north east London accident and emergency department.
In a plan that foreshadows his forthcoming national strategy, he suggests closing one of three A&E departments, opening a network of urgent care centres to deal with less serious illnesses and injuries, and transforming the hospital that loses its A&E into an elective surgery centre with a polyclinic providing GP, community nursing and outpatient services.
Sir George's report into the reconfiguration of health services in Barnet, Enfield and Haringey endorses the PCTs' proposals to close the A&E at Chase Farm Hospital in Enfield. This has been opposed by local papers as well as the local Labour MP Joan Ryan, who is a Home Office minister.
Sir George concluded that the health economy, with a population of around 900,000, is too small to support three major A&E departments, currently provided at Chase Farm, North Middlesex and Barnet hospitals. His report said: 'Put starkly, it is evident that safe, high-quality modern care cannot be provided for all specialties in all three acute hospitals in the area. This was clear from discussion with many clinicians. There are insufficient doctors, particularly at a senior level, buildings are inadequate and resources are finite.'
He proposes concentrating major trauma centres and consultant-led obstetrics at Barnet and North Middlesex Hospitals and setting up doctor-led urgent care centres at strategic points around the patch. These would be primary care services, open from 8am to midnight.
Each of the three hospitals would have an urgent care centre and at Chase Farm there would also be a medically led assessment service for elderly people and a consultant-led daytime paediatric assessment unit open from 8am-8pm.
Sir George said there was no intention to close Chase Farm Hospital: 'Chase Farm is safe. Anyone who tries to close it does so over my dead body,' he said.
But he added he was determined to see his plan succeed. 'I do not intend to end my career by failing in Barnet, Enfield and Haringey,' he said. 'I want to see better healthcare here and I think we have got a way to do it.
'It's a model of care you will see in the urgent care strategy published at the end of the month by the Department of Health. I have been working out the principles of that to the local situation and I am very keen to get it up and running as quickly as possible.'
Other elements of the plan include establishing an urgent care board to take forward timed proposals.