There is only one thing worse than being talked about and that is not being talked about. The what, where and how of our work has, at the time of writing, extensive media coverage; the government has released proposals to streamline emergency care with closure of accident and emergency departments [sic], development of super (regional) accident and emergency departments [sic] and urgent care centres, extended paramedic responsibilities and so forth. It seems, at face value, that there are three reasons for these proposals, namely money, employment law and clinical outcomes. It is difficult to determine if they are mutually exclusive.

In September 2006, the then new NHS chief executive, David Nicholson, said that “up to 60 hospital closures might affect accident and emergency, paediatric and maternity departments especially in the smaller district hospitals. Some of the changes would be aimed at reducing the NHS deficit of £512 million last year”. He continued “I understand the politics of it, but this is about the way we deliver care which is predominantly closer to home.” What does that mean? In relation to the NHS deficit he mentions, is it a non sequitur?

In December, the Conservative Party reported that 29 accident and emergency units [sic] face closure; the scale of the potential closures underlines a financial crisis which saw front line trusts run up a £1.3 billion deficit last year. Three quarters of the accident and emergency units under threat were in trusts that were deeply in the red. The 29 departments at most risk are in trusts with a combined deficit of £287.2 million last year. Only seven of the trusts considering closing …