NHS shake-up aims to decongest busy A&E departments

By Shane Tyas and Helen Davidson

According to NHS chiefs a new NHS two-tier system should be created to reduce numbers of patients in A & E and therefore cut down on waiting times and pressures on A & E departments. This new system has been brought in to make sure that a good quality of care is maintained for everyone.

How the Two-Tier System Will Work

The new system (diagram below) will focus on more care services to be available in the community and in patient’s homes.

Alternative services include more efficient advice over the phone, more GP and primary care arrangements, urgent care centres, more paramedics available to treat patients at home or at the scene of an accident and better support and advice to be available at community pharmacies.

A & E will be split into two categories:

1) A & E departments dealing with 999 emergencies including life-threatening injuries and illness.

2) Care services outside A & E departments dealing with non-life-threatening and minor injuries and illness that can be dealt with outside hospital and do not need emergency treatment.

ae system

More serious cases will be kept separate: 40 to 70 units known as major emergency centres or Major Trauma Centres will be opened to deal with heart attacks, strokes and trauma.

Major Trauma means multiple, serious injuries that could result in death or serious disability; these might include serious head injuries, severe gunshot wounds or road traffic accidents.

For some less serious and non-life threatening cases that do need hospital attention 70 to 100 A & E centres will stay open to deal with them known as Minor Injuries Unit (MIUs).

MIUs basically deal with any injuries or abrasions that are not non-fatal or severely damaging injuries. Main examples for this are broken bones, wound infections, sprains and strains.

Problems that will be addressed with the new system

Anyone who has had to go to A & E any time over the past few years with non-life threatening problems would have experienced waiting times lasting hours.

Patient numbers have risen by around 50% in the past decade putting further strain on emergency services. This number is predicted to go up even further.

Almost 10 years ago the Labour government set a four hour waiting target for A & E. The aim for departments all over the UK was to have treated and discharged at least 98% of patients within four hours of their arrival. However by the end of December 2004 it was revealed that these targets could not be met. Around 48 percent of A & E departments in the UK admitted that they could not achieve this.

It is clear that the only solution to this problem is to reduce the numbers of patients in A & E especially if they do not need to be there to be treated effectively.

Statistics have shown that 40% of patients admitted to A & E are discharged having not needed any treatment wasting a huge amount of the NHS’s time and money.

Also the excessive amount of people admitted into A&E could be avoided if adequate treatment in the community and from GPs was given to begin with.

The new system will ideally cut down on the number of people needing treatment in A & E by creating more medical staff who can treat non-life threatening injuries and illnesses in the patients own home, in the community and at the scene of an accident.



The main problem with A&E has always been the lengthy wait for most individuals who might have a serious injury but due to others emergencies, have to wait several hours.

Can introducing a two-tier system differentiating between minor and severe cases really take pressure of A & E?

Facilities already set up targeting the key issue of overcrowding have already faced problems; one that springs to mind is the 111 telephone service, created for non-emergencies aiming to free up the 999 service.

For many patients, seeking advice over the telephone is not always effective because they may feel they need more responsive services, reliable information and one to one meetings from GPs and nurses.

There are also similar issues with GP’s Surgeries; many patients have complained that they have to wait far too long, making themselves at risk of becoming more poorly and therefore increasing the chances of them having to be admitted to A&E instead.

Public Reactions

Earlier today we spoke to Lois Barradell, 23, cafe Worker at The Dumb Waiter, in the North Laines, Brighton about her experiences with the NHS.

Answering the question of how easy she has found it to book an appointment with a GP, she responded:  “In general I’ve never found it too difficult, I go to a surgery where my mum lives in Seaford and it’s pretty good, I can usually get an appointment within a week.”

Concerning the question of whether introducing Major Trauma Centres will relieve the pressure on A&E, she said: “Yes I think it will be a good idea, it will definitely ease congestion because it’s no good when people who have serious problems don’t get seen straight away”

We also interviewed Penny Melia, who works for the Crime Reductions Initiatives (CRI) National Charity, who shared with us her opinions on the recent changes.

She said: “Personally, I’m very nervous about the emphasis on market forces being applied to the National Health Service, and also concerned that private companies will put profit before people.”

When asked about whether the 111 service should remain as a way of taking pressure off just the 999 service, she answered: “I’m not sure what the problem was before, when I broke my wrist, I called the 111 service instead of going to A&E, and I couldn’t go to the doctors either, but the NHS were very help, and I got treatment almost straight away.”

The idea of separating A&E services based upon severity seems sensible but has been met with mixed public views. Will the changes prove to be successful? Time will tell.


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