The secret is out: not all A&Es are equal

Woman with finger to lips A&E services have been evolving for years

It has been an open secret in the NHS for years, it's just that nobody has been honest enough to tell patients. Until now.

In unveiling his new vision for urgent and emergency care, NHS medical director Prof Sir Bruce Keogh was upfront. "Not all A&Es are equal," he said.

In fact, you probably have to go back to the 1970s to find a time when all A&Es could offer the best treatment of the day.

Since then the advancement of medical science has meant specialist care has had to be focussed at fewer and fewer sites.

Take heart attacks, for example. Forty years ago patients were treated with bed rest and the hospital mortality rate was about 25%.

Over the years specialist units were set up and clot-busting drugs used.

Then in the 1990s it become clear the way forward was to mechanically unblock arteries.

Mortality rates have now been reduced to 5%.

But only about half of hospitals have the specialist equipment and doctors to provide the latest expert care.


Similar changes have happened in other areas from stroke services to trauma care.

One in five A&Es don't even have specialist children's services now.

It means the brand A&E has become almost meaningless.

Take Leeds and its surrounding areas stretching from Harrogate in the north to Barnsley in the south.

There are 10 hospitals with an A&E unit, all with varying degrees of expertise. By far the biggest and most important in the region is Leeds General Infirmary which deals with all the major trauma.

Comparing that to the unit at say, Dewsbury, is like comparing apples and pears. They are simply not the same.

And that is why splitting A&Es into two distinct groups - as Sir Bruce is proposing - makes a great deal of clinical sense.

But the problem now is the politics of it.

While in many areas the creation of a two-tier service has already happened in all but name, there are plenty of areas where it has not.

If and when that happens there will be a sense - rightly or wrongly - of some areas losing out.

As a result, making those decisions will become highly controversial, as Nigel Edwards, of the King's Fund think-tank acknowledges.

He says while the solutions are the right ones they will be "hard to sell" and "difficult to implement".

Nick Triggle Article written by Nick Triggle Nick Triggle Health correspondent

The secret to transforming a failing hospital

Turning around a failing hospital is the equivalent of the holy grail for the NHS. Basildon Hospital has done it. So what is the secret of their success?

Read full article


This entry is now closed for comments

Jump to comments pagination
  • rate this

    Comment number 104.

    Re 101. Prole. (Cont) Indeed, sorting "hospital flow" and in-patient capacity should be a priority for those in charge. Unfortunately it doesn't always appear to be. That's why I genuinely think yesterday's announcements were more about a "smokescreen" and spin than actually tackling the problems head on. There are some positives from yesterday but money and resources are needed - where are they?

  • rate this

    Comment number 103.

    Re 101.Prole. It is impossible to comment with certainty but it sounds as though there are / were no beds to admit your father in the main hospital directly to and the default is often to send the patient directly to A&E. The general lack of main hospital capacity and "bed blocking" are major contributory factors to A&E business. I sympathize but this is not the fault of the front line A&E staff.

  • rate this

    Comment number 102.

    Re: 100 Steerpike. It's unclear from your comment exactly what your working experience in the NHS is. Are you really an A+E consultant with 34 years front line experience? If so I find your views incredible. There are many front line doctors providing the best service they can under difficult circumstances. What exactly do you do? How much experience of treating seriously ill patients do you have?

  • rate this

    Comment number 101.

    @99. As a senior A&E doctor, can you explain to me, why, when both GP's and OOH's doctors have requested my father is admitted [to the Bradford Royal]. They simply refuse the GP's requests? And say he has to go to A&E instead?
    Happens time and time again. Could this be a reason why A&E is so busy? Because GP's and OOH MD's requests to admit sick patients are ignored?

  • rate this

    Comment number 100.

    Re: 99. D-Geggie

    I'll see your 20 years and raise you a further 14.
    I feel that its well past the time that doctors came out of their ivory towers and joined the real world.
    Yes, there are many working hard throughout the country attempting to provide the best service they can under difficult conditions. Unfortunately, few are doctors.

  • rate this

    Comment number 99.

    Re 97.Steerpike. I'm an A+E senior doctor with over 20 years experience at the sharp end and find your comment offensive. In general, there are alot of dedicated staff working extremely hard to keep A+Es up and down the country functioning. Incidentaly, where ever you are in A&E it's highly probable that you be only able to see a small fraction of what is going on - don't be so ignorant!

  • rate this

    Comment number 98.

    The NHS, like any diverse organisation fails when its management is overrepresented by any single group. Gaining authority, they give undue creedence only to their own, their narrow view is perpetuated and becomes the only acceptable one.
    The doctor-centric NHS serves their needs, not those of the patients yet who do we entrust the review of the NHS to?
    Any guesses what his solution will be?

  • rate this

    Comment number 97.

    A&E overstretched?
    For the answer, just drop in almost any time and see who's sitting at, or more usually on, the central station having a chat. The seniority of doctor determines the backside-time and very few can be coaxed into actually dirtying their hands on the sick.

  • rate this

    Comment number 96.

    I'm sorry but THIS IS NOT NEW. The keogh report and the government seems to be spinning this 2 tier system as a solution to the up coming "Winter A+E crisis." It won't solve this and actually is already in place over the majority of the country. Where is the much needed urgent investment in A&Es? Hunt - please stop spinning and act desicively now!

  • rate this

    Comment number 95.

    Having just spent 3 weeks in hospital after being taken to A&E I have nothing but praise for Newcastle upon Tyne's emergency service.
    I was seen within 15 minutes of arriving and the following day underwent surgery.
    It is only right that minor injuries and self inflicted harm caused by alcohol and drugs are delayed for more serious problems.
    Common sense really.

  • rate this

    Comment number 94.

    There is no perfect system but ours has not been helped by the introduction of 'managers' whose purpose is to make the service fit the budget. In some areas that is easier to do than in others. Thus,one A&E unit will see you,diagnose you,treat you and send you home before another has even taken down your name and address. It's called Thatcherism. Cost of everything,value of nothing.

  • rate this

    Comment number 93.

    "The NHS is safe in our hands"

  • rate this

    Comment number 92.

    The NHS is very inconsistent in it quality of service.
    Why? Mostly because many employees do not feel that they are offering a service and forget who the customer is. Us the tax payer
    Myths abound about the NHS here in the UK such as 'it is the envy of the world' , 'it is the best in the world' and ' the only alternative is the USA system'. All complete socialist lies.
    Massive change is required

  • rate this

    Comment number 91.

    Like the Professional Footballer with a broken leg doesn't want the St John's touching it, rather an orthopaedic unit with X-ray and skilled practitioners...
    When I have an MI I want trained who recognise the symptoms to pack me up, keep me alive and whisk me direct to the best team in the country for MI not a group of over worked generalists .. see CVA, spinal injury and the rest

  • rate this

    Comment number 90.

    Two quotes regarding Dewsbury Hospital,

    (Pinderfields and Pontefract) are both PFI (Private Finance Initiative) and unlikely to close.
    “I’m not sure they listened to the people. It seems as though they went through the process and then steamrollered the decision.

    As usual Politics before people, enough is enough.......

  • rate this

    Comment number 89.

    It's no surprise when you look at the ridiculous treatment of the NHS. The biggest surprise is that some places still have A&E. The health service in my town has turned into an absolute joke these past few years.

    If there's anything at all we should stick together to protect it's health services. They should be improved across the country. Everything else pales into insignificance if you're dead.

  • rate this

    Comment number 88.

    87.Bernardus88 - "............Many paramedics don't have this. I'm an A&E doctor."

    Of course you are..........!!!!!!!!!!!

  • rate this

    Comment number 87.

    What terrifies me is the idea of "enhanced" paramedics diagnosing and treating people outside of the hospital. They may be competent to follow protocols in some situations but I really think that diagnosis needs a lot more education and experience than they have or will have. You need a certain level of knowledge to know what you don't know. Many paramedics don't have this. I'm an A&E doctor.

  • rate this

    Comment number 86.

    I am very pleased with the A&E at Kings Mill Hospital.In spite of some faults this department did all that it could to make my stay pleasant.I have a heart condition and from the arrival of the ambulance everything went smoothly.The staff were first class and I have no moans.

  • rate this

    Comment number 85.

    It has been an open secret for a long time that most hospitals do not have much clue what demand there is for which services, nor how best to meet that demand.
    The decision about which A&E is appropriate for any case must be made by a clinician, which means that many people will start at the wrong A&E. This is either a waste of time all round or a danger to the well-being of the patient. Ouch !


Page 1 of 6



BBC © 2014 The BBC is not responsible for the content of external sites. Read more.

This page is best viewed in an up-to-date web browser with style sheets (CSS) enabled. While you will be able to view the content of this page in your current browser, you will not be able to get the full visual experience. Please consider upgrading your browser software or enabling style sheets (CSS) if you are able to do so.