Why A&E cutbacks will cost lives, Labour is told

They say the further seriously-ill patients have to travel by ambulance, the more likely they are to die.

The risk of death rises by one per cent for every six extra miles.

The findings by a Sheffield University team are a major blow to Government plans to replace the local units with a smaller number of trauma centres.

Ministers claim these will save lives by providing more specialised care.

But Professor Jon Nicholl, director of the university's Medical Care Research Unit, said some emergency patients had been overlooked.

They are those whose conditions are lifethreatening but do not need specialist care, including patients who are in anaphylactic shock, choking, drowning or having an acute asthma attack.

Professor Nicholl said: "They need urgent care that would be the same wherever it is provided. It is more likely that these patients would survive by travelling a short distance to a local A&E department rather than travelling a long distance to a specialist hospital."

The findings are based on a review of lifethreatening - category A - calls to four ambulance services in England between 1997 and 2001. They represented urban, rural, mixed and remote areas.

The researchers studied ambulance journey of up to 36 miles involving 10,000 patients who were unconscious, or not breathing or who had chest pain.

A total of 644, six per cent, died. The further patients had to travel the more likely they were to die. Among patients who travelled 13 miles or more the death rate was almost nine per cent.

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The survey report, in the Emergency Medical Journal today, says the patients most likely to be affected by extra distance were those with severe breathing problems. Their chance of dying was 13 per cent for a journey of six to 12 miles, but soared to 20 per over further than 12 miles.

The controversial shake-up plans include local urgent care treatment centres, staffed by GPs and nurses and treating problems that are not life-threatening.

Large specialist centres will treat critical emergencies such as heart attacks and multiple serious injuries.

Don MacKechnie, president of the British Association of Emergency Medicine, said last night the study provided the first evidence about the impact of spending longer to get to casualty departments.

He said: "We have felt there might be an issue and this well-conducted study shows a rise in mortality among some patients.

"We urge the Government and those who make policy to take this information into account in future. The distance and time taken to get patients to hospital has to become part of the equation."

Geoff Martin of the campaign group Health Emergency said: "This study nails the bogus argument that you can get away with closing A&E units without putting patients' lives at risk. The Government is condemning to death seriouslyill patients who have to travel long distances."

Tory health spokesman Andrew Lansley said: "This is exactly the kind of evidence we need to determine access to accident and emergency services.

"It undermines the Government's claim that closures are determined on a clinical basis, when in reality they are being driven by deficits and pressures from the European working time directive."

Michael Summers of the Patients' Association pointed out that some Cabinet ministers supported the policy of A&E closures but had defended their constituency hospitals from such threats.

He said: "Thousands of patients up and down the country are equally concerned. New trauma centres are not going to materialise overnight, local A&E units may be shut and there are no guarantees that seriously-ill patients won't spend worryingly long periods in ambulances before getting help."

The Department of Health said the study was out of date.

A spokesman said: "Paramedics and nurses are much more than a patient taxi service. Many ambulance staff are trained to assess, diagnose and provide treatment at the scene.

"The study looks at the survival rates of people with serious breathing difficulties and chest pains.

"The aim should always be to provide high quality care for them close to home where this is clinically safe, but some patients may require more immediate specialised care at centres with clinicians who have the right expertise and equipment."