A&E closure plan could cost lives, Labour told

Clinical leaders say there is "no evidence" to support Labour's planned downgrading of district general hospitals, insisting most should continue to "provide a full emergency service".

In a report being published today, the Academy of Medical Royal Colleges flies in the face of Government claims that doctors support their plans to close smaller casualty units and make patients travel further to regional "super A&Es".

It backs a report by Sheffield University which said closures would cost lives as the further a seriously-ill patient was driven by ambulance, the more likely they were to die.

The risk rises by one per cent every six miles.

NHS chief executive David Nicholson says 60 hospitals may have to close or downgrade their A&E and maternity units to fit in with Government plans to create a three-tier system for emergency care.

Patients with the most serious conditions would be treated in "super A&Es", while other problems would be handled at smaller "minor injuries units" or by paramedics in the home.

The Government- commissioned report backs proposals by ministers to centralise specialist and complex operations in regional supercentres.

But it adds: "The evidence is much less clear for the majority of common conditions that make up 95 per cent of acute care.

There is evidence that larger emergency departments have longer waiting times. Big is not necessarily better."

Tory health spokesman Andrew Lansley said: "Gordon Brown is misleading patients by saying district general hospitals should be downgraded.

"Now the medical royal colleges back what David Cameron and I have been saying, that these closures are driven by financial deficits, the European Working Time Directive and the Government's belief that bigger is better despite public outcry at limited access.

"Hospital closures are not being driven by clinical evidence."

The Government warns some small hospitals may not be able to support A&E departments because they will not have a full range of specialists.

But Professor Ian Gilmore, president of the Royal College of Physicians and co-chairman of the working party which drew up the report, told the Health Service Journal this should not be a problem.

He said: "We think most district general hospitals should be able to provide A&E."

Jim Wardrope, president of the College of Emergency Medicine, said Government plans to centralise A&E services concentrated too heavily on those with serious injuries and threatened to put those with more minor complaints at risk.

The report criticises Government initiatives such as NHS Direct, minor injury units and walk-in centres, saying there is no evidence they had been cost effective or cut demand on hard-pressed A&E departments.

The planned reorganisation came under further attack last week when Sir Derek Wanless, the architect of Labour's policy towards the NHS, said there were "question marks" over the evidence used to close hospitals.

The Department of Health said yesterday: "We expect the report to confirm our view that the main driver for reconfiguring services should be to sustain and improve high standards of care."