Healthier Together

Why Change: Accident & Emergency

Accident and Emergency (A&E) departments are the front door of the hospital and are where most patients with an urgent and emergency condition go to for their care.


Right care, Right place, Right time - saving lives

The number of patients going to Accident and Emergency (A&E) is increasing year on year nationally and in Greater Manchester (GM) the number is rising faster than expected due to our growing population.

Fact: In 2012 – 2013 1.1million patients attended A&E

As the number of people attending A&E rises e.g. nearly 95,000 more patients attending A&E in Greater Manchester compared to 3 years earlier in 2009 – 2010.

Note: that's equivalent to an additional 255 patients attending A&E in GM every day in 2012 – 2013.

In simple terms this is like us having an additional A&E! 

Fact: This increase means our A&Es departments are very busy and struggling to cope.

Some patients who go to A&E are extremely ill – with a life threatening illness or injury. These patients need high levels of care from experienced doctors and nurses.

National standards set out how A&E departments should be run and the ways in which sick patients should be cared for. At present we are not meeting these standards.

The standards also describe how and when care should be delivered and by whom and include guidance around the hours per day there should be an A&E consultant working in every A&E.

As part of working to meet the standards senior doctors and nurses have identified 45 of these standards that we would like every A&E in Greater Manchester to achieve by doing things differently.

Fact: Unfortunately, none of our A&Es in Greater Manchester currently meet the standards.

staff.pngThe Healthier Together standard is for a consultant to be present in A&Es for a minimum of 12 hours per day, 7 days a week. 

3 out of 8 Trusts currently meet this standard.

Healthier Together wants to upgrade consultant presence in all A&Es to at least 12 hours, some to 16 hours and some to 24 hours.

At the moment there are not enough doctors and nurses available to help us achieve these standards.

This is partly because fewer junior doctors are choosing to become A&E doctors as its's seen as a very challenging job. Nationally there is a shortage of experienced and junior A&E doctors.

Therefore, even if money was no object, we cannot meet the standards for A&E doctor staffing in every hospital in GM.  

Patients arrive at A&E with various conditions and ailments – from a broken arm and cut needing stitches, to a heart attack or injuries following a serious car crash.

The type of care they need relates to how seriously ill they are. For example, a patient needing a few stitches would not need any treatment from an experiended A&E consultant.

A&E departments match the type of care that each patient needs to the doctor or nurse treating them by assessing each patient as they arrive. 

Most patients attending A&E have a minor illness or injury and a smaller number are very sick and need specialist care. In most cases, patients who are extremely sick should be cared for by an A&E consultant.

This means every A&E needs to have enough consultants over enough hours per day to care for the few very sick patients arriving in A&E.

However, as there are relatively less very sick patients per day, per A&E, so this is not a very efficient model and means these specialist A&E (consultant) doctors are  currently spread thinly across our A&E departments.

Fact: we need to change to ensure that our A&E departments meet national standards and provide the best care.

What is being proposed for A&E?

It is proposed that we have two different types of A&E in Greater Manchester:

Specialist hospitals A&E - 4 or 5 hospitals will be will be home to A&E's that provide care for the smaller numbers of extremely sick patients.

- Local General hospital A &E - this A&Es will open 24 hours per day and care for other patients who attend A&E * this is the vast majority*.

Both A&E's in Specialist and local General hospitals will be upgraded to meet all of the standards.

There will also be an investment in 20% more A&E consultants across GM to make sure our A&E departments meet the standards. Specialist and local General A&Es will work together in 'shared' or ‘single services’.

The single service will be formed of one Specialist and one or two local General hospitals and will have a shared team of A&E doctors and senior nurses. We hope that working this way will help us to achieve better standards of care in every hospital.

Will my local hospital or A&E close?


No. The Healthier Together consultation is not proposing that any hospital or A&E will close.

In fact, a key aim of the programme is to ensure that services are provided close to home where possible.

This means that services that can be provided in every local hospital to include: a 24/7 A&E department, an acute medical unit, low risk planned general surgery, intensive care, outpatient appointments, scanning and diagnostic services.

How will I know which hospital to go to?

We've worked closely with the North West Ambulance Service (NWAS) and senior doctors and paramedics from NWAS have been involved in designing the model of care.

Somel emergency services are already only delivered in a few hospital sites. For example if you became a patient as a result of injuring your head in a car crash (trauma) in the here and now.

The paramedics who respond to your emergency will use a tool called Pathfinder to help them work out which hospital you need to go to for the specialist treatment you need.

The same Pathfinder tool will be used in the future for paramedics to work out which hospital you need to go to for your treatment. The paramedics will therefore take you to the hospital that providest specialist trauma care.

If you arrive at hospital by ambulance, the doctors in A&E will assess you and if they decide that you need to go a specialist hospital for your treatment.  

They will arrange for you to be taken directly to right hospital for the appropriate care, from a doctor that specialises in trauma in the appropriate hospital.

What does this mean for me?

  • You will receive the majority of your care locally
  • If you become very sick you will receive the very best possible care
  • Paramedics will make sure that you are taken to the right hospital for your care
  • All A&Es will be upgraded to meet the standards


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