PLANS to create a two-tier A&E system have been labelled “the most significant” reorganisation of emergency care in the history of the NHS by a top Worcestershire watchdog.

NHS medical director Professor Sir Bruce Keogh has announced a vision for a new national network of between 40 and 70 Major Emergency Centres – branded ‘super A&Es’.

These will be complemented by a wider network, dubbed simply Emergency Centres, capable of “assessing and initiating” treatment for all patients and transferring them to larger units if necessary.

The concept of centralising A&E services is already familiar in Worcestershire, where debate has raged for more than 18 months over the possibility of downgrading the emergency department at Redditch’s Alexandra Hospital in favour of an enhanced operation at Worcester.

The Keogh report says the overall number of emergency centres would be “broadly equal” to the current number of A&E departments.

And Worcester’s MP Robin Walker said the number of major A&Es being proposed means the county is not at risk of losing services.

“I don’t see this as something that is changing the nature of the process going on in Worcestershire, it is part of the background to it,” he said.

“If you talk to the clinicians they would all accept that there is a logic in concentrating services.

“I don’t think that there will be any concern looking at these Keogh suggestions that Worcestershire as a whole will lose any services.

“It is about how we best configure them.”

Peter Pinfield, chairman of watchdog Healthwatch Worcestershire, labelled the report “the most significant plan to re-organise urgent and emergency care since the establishment of the NHS in 1948”.

He said: “There is just too much going wrong with the present system.

“Clearly, the country could not go on without a radical rethink of how A&E services should be provided.

“I think Sir Bruce’s report is hard hitting, factual and has a number of interesting, challenging proposals.

He added: “Worcestershire is not alone in having to review its acute and emergency services and in many other parts of the country we are seeing communities arguing and split on what is the best solution.”

Other elements of the report call for ambulances to become ‘mobile urgent treatment services’ and for half of all ambulance patients to be treated at the scene and not taken to hospital.

Anthony Marsh, chief executive of West Midlands Ambulance Service, said: “We very much welcome the report and its findings, as it supports the views that we have been expressing for some time and in some cases what we are already doing in the West Midlands.”

Sir Bruce said changes to A&E will only be implemented once a wider transformation to enhance urgent care in the community and away from hospitals has taken place.

He described the current system as “under intense, growing and unsustainable pressure”.

On the proposed transformation of A&E, he said: “A&E departments up and down the country offer very different types and levels of service, yet they all carry the same name.”

A spokesman for Worcestershire Acute Hospitals Trust said: “We particularly welcome the commitment to improving out of hospital care and ensuring that those people who do not need to access accident and emergency services are treated in more appropriate settings.

“This will enable us to concentrate on those patients who really need to be in A&E.”