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NHS England proposals for a two-tier A&E

Eivor Oborn is a Professor of Healthcare Management at Warwick Business School and has researched the NHS organisation and worked alongside former health minister Lord Darzi. She gives her thoughts on NHS England proposals to set up a two-tier A&E.

Professor Eivor Oborn said: "This is a possible solution and is similar to what was set up by Lord Darzi in London, but people didn’t like it because it implies shutting or downgrading some A&E departments. Politicians hesitate to do this as it may lead to political suicide (a key lesson from the Kidderminster hospital reorganisation); so a two-tier system is a possible solution, but only if it is adequately resourced and managed and if the local public are engaged in the process. It might be easier for administrators but it might be still up to the patient to decide which A&E they go to and then you have the same problem. These people need to go somewhere after all.
It is dangerous to decide on a one-size fits all approach, what works in London might not work in Shropshire. We need to develop locally prepared solutions that fit into the current infrastructure.
What is really needed is better community care from the GP surgeries with community-based centres. People need adequate access to GPs and community-based urgent care centres would relieve the pressure on A&E attendance as stable patients could be monitored in the community. Social and community services could have ring-fenced funding to support hospital discharge. In addition, Clinical Commissioning Groups (CCGs) and GPs more widely need to be incentivised to work more closely with hospitals and vice versa to develop innovative and locally relevant solutions.

A number of A&Es have coped with the four-hour target pressure they are under by setting up a parallel ward for observation; more of this should be encouraged. This way full admission is avoided but a crisis can be averted with a more realistic timeframe for getting a community package in place.”

To arrange an interview with Professor Oborn, contact Ashley Potter on +44 (0)24 7657 3967 or +44 (0)7733 013264.