Sure we've already rationalised to almost that extent in many units. How 
often do you see surgeons operate at night these days anyway? And even when 
you do have something urgent they take ages to get their act together. Most 
of ours are non-resident now so you can see the attraction in rationalising 
services into larger centres. And such centralisation already occurs for 
many subspecialties, particularly surgical subspecialties.

AF

----- Original Message ----- 
From: "Andrew Webster" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, March 23, 2006 9:39 PM
Subject: Coming to a department near you soon?

More rationalisation of services threatened with PBR?

Acute plans call for A&E split
Emergency surgery and trauma services would not need to be provided on the
same site as accident and emergency departments under controversial
proposals submitted to the Department of Health.

The National Leadership Network, which was asked by the government to draw
up plans for the shape of acute hospitals under choice and payment by
results, has specified what it sees as the 'core' services to be protected
at all hospitals with A&E departments.

The proposal to protect some services responds to concerns that the new
market could lead to the closure of services which were financially unviable
but needed to support A&E.

The document identifies the services - such as 24-hour access to acute
medicine and diagnostic radiology - which the authors say should be 
protected.

But they say some other services, such as emergency surgery, which are
required by A&E teams need not be provided at the same hospital, but
elsewhere locally.

These services should be protected by the beefing-up of multi-hospital
networks, perhaps through the establishment of joint ventures between
trusts, the report says.

Primary care trusts and practice-based commissioners will also be expected
to ensure all patients have access to the necessary A&E services.

Project director Martin Hensher said: 'Present multi-hospital networks are
soft partnerships between trusts and in some places there are reports of a
bit of trouble where foundation trusts are part of networks.

'We have suggested ways of making networks more robust organisational
structures, with firm contracts between trusts.'

The document says A&E departments should be supported on site by 24-hour
access to acute medicine, level-two critical care, a non-interventional
coronary care unit, an essential services laboratory and diagnostic 
radiology.

However, the following services need not be provided on site and should be
supported by 24-hour local multi-hospital network access:

emergency surgery; trauma and orthopaedics; paediatrics; obstetrics and
gynaecology; mental health; specialised surgery and interventional 
radiology.

Dr Dermot O'Riordan, chair of the Royal College of Surgeons reconfiguration
working party, said if there was not emergency surgery on site, an A&E
department would not be able to admit someone with, for example, intestinal
bleeding.