Up to 15 hospitals in one English region alone may need to downgrade to ensure that all accident and emergency units can operate safely, a new study claims.

Up to 15 hospitals in one English region alone may need to downgrade to ensure that all accident and emergency units can operate safely, a new study claims.

The report from the Institute for Public Policy Research says a reconfiguration of 58 hospitals - one in four in England - might be essential to ensure that A&E wards are given enough back-up.

This national figure aligns with NHS chief executive David Nicholson's comments last week that around 60 hospitals might have to be reconfigured.

But while Mr Nicholson indicated that the changes would occur evenly over the country, the IPPR survey says the closures would be concentrated in the North and in London. The survey says 15 general hospitals should downgrade in the North West if A&E wards are to operate safely. A further nine would reconfigure in the North East together with nine in London - with the other 25 changes spread across the country.

The findings are based on the Royal College of Surgeons recommendation that hospitals providing emergency surgery should serve a minimum of 300,000 people.

Only two strategic health authority areas - South West and South Central - meet this figure.

The average catchment area of general hospitals in the North West has a population of 210,000. To reach the Royal College of Surgeons minimum, this would require the closure or merger of 15 hospitals (nine in Cumbria and Lancashire; five in Greater Manchester and one in Cheshire or Merseyside), according to the IPPR.

IPPR associate director Richard Brooks said there were simply too many hospitals in England. 'Acute care, like A&E and specialist surgery, needs to be concentrated in fewer locations so that doctors with the right skills, experience and equipment are available to treat the sickest patients safely,' he said.

'More routine services could be provided locally outside general hospitals in community centres more accessible to people who need them.'

He said the figure of 58 indicated the number of small A&E departments that would need to be merged with larger centres. Other services, such as minor injuries units, outpatients, diagnostics and rehabilitation could remain on existing sites or provided more locally in community hospitals, he said.

The Department of Health declined to comment on the regional spread of reconfigurations predicted by the IPPR.

A spokesperson for North West SHA said there would be big changes but predicted that hospitals in the North West would 'change rather than close'.