Can we afford to close any more A&E departments? Evidence from North West London

Closing A&E departments has led to a deterioration in the performance of those that remain in North West London. This analysis warns of the risk to patients if further A&Es are closed.

Across England NHS Sustainability and Transformation Plans (STPs) are proposing the closure or ‘downgrade’ of up to 24 emergency departments.

This analysis shows how A&E performance has suffered across North West London following the closure of two emergency departments in 2014.

Performance against the 95% 4-hour wait target dropped to as low as 60% shortly after the closures, meaning that up to 40% of patients requiring serious treatment had to wait over 4 hours to be assessed and admitted to an appropriate bed. Since then the performance of North West London hospitals has been some of the worst in the country, sometimes managing to treat fewer than half of the patients within four hours. For time-sensitive conditions such as sepsis or respiratory failure such delays are life-threatening.

In addition, since the A&E closures in 2014 the bed occupancy rate in all hospital trusts in North West London has been above 85%, compromising clinical safety through overcrowding.

This paper also points out that the closures aggravate health inequalities, hitting the most deprived boroughs in the region.