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Patient travel distance to A&E static despite closures

Longer distances to A&E could mean more reliance on GPs

Adrian O'Dowd

Wednesday, 19 February 2014

The distances that patients have to travel to A&E departments in England have remained stable over the past 10 years despite closures in that period, concludes a new report from health think tank The Nuffield Trust and the Health Foundation.

The report, however, has warned that planned reconfigurations of A&E services could mean patients will face much greater distances to reach these departments while there may be more reliance on primary care services.

In the report Focus On: Distance from home to emergency care, the authors looked at more than a decade’s worth of data on emergency admissions in England between 2001-02 and 2011-12 to assess how the distance from home to hospital has changed for patients who need emergency care.

The report is published alongside a set of interactive maps that trace home-to-hospital distances over time by the Nuffield Trust and the Health Foundation as part of QualityWatch, a research programme examining the quality of patient care in England.

The study found that despite the total number of emergency admissions rising by over a third in 10 years, the average distance from home to hospital has only increased by 0.2 miles.

In 70% of cases, emergency admissions happened within 6.2 miles of a patient’s home, and only 3% of people were admitted to a hospital more than 18.6 miles from home.

However, the research also showed that people in some rural areas have to travel more than 10 times as far as those in urban areas.

Under proposed changes to A&Es in England outlined in the recent NHS England review into urgent care, NHS medical director Sir Bruce Keogh recommended fewer and better-equipped major A&E departments for the most serious cases.

The report’s authors warned this could mean that some patients in remote areas would have to receive emergency care further from home even though changes could mean better quality of care overall.

Nuffield Trust senior research analyst and report author Adam Roberts said: “Despite concerns around major A&E departments being closed or downgraded, our analysis shows that the average home-to-hospital distance for patients who receive emergency care has remained remarkably stable over the past decade.

“In the future, designating 40-70 major A&E departments, as recommended in Sir Bruce Keogh’s review, would likely result in an increase in home to hospital distances for some patients.

“If this resulted in a better standard of care upon arrival this could lead to better outcomes, as the recent reconfiguration of stroke services in London shows. But careful planning will be needed to ensure that this does not adversely impact patients in rural areas where the distances involved are much greater.”

Greater distances to travel could also impact on primary care services, as Dr Judith Smith, director of policy at the think tank, told OnMedica: “Countries where the home-to-hospital distances are much greater than England's manage this through using GPs, nurses, community hospital teams and their extended primary care teams in a wide range of ways.

“They are increasingly supported by telemedicine which provides local practitioners with links to specialists and diagnostics in major centres, all supported by strict protocols.”

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