• Emergency care systems

The Kings' Fund will be familiar to many readers. In September, it published a briefing paper, with the above title1 that appears rather dry and of no immediate interest to readers; close scrutiny, however, reveals some interesting comments and perspectives that should be noted.

The reason why the Fund feels it necessary to comment on this subject is that, while acknowledging that reconfiguration of hospital services can provide a powerful means of improving quality in an environment where money and skilled healthcare workers are scarce (and in some places reconfiguration is needed urgently), the current reconfiguration process is lengthy, wasteful and carries significant risks to the delivery of safe services. There are also risks that prospective legislative changes will make an already complex and bureaucratic process become more so and that there will be a lack of the strategic leadership required to lead and deliver change.

The paper opens with a high-level summary of how the NHS has changed in 50 years; in line with international trends the number of acute hospitals has reduced by 85% and the number of sites at which highly specialist care is delivered has reduced even further. In England, general acute care is now delivered in just over 200 hospitals and the average size of a hospital has grown from 68 beds to just over 400 beds; …