Middle way could be A&E cure

Published on Thursday 7 June 2007 01:22

AS EXPECTED, the SNP has reversed a decision made by the previous Executive to close local A&E units in Ayr and Monklands, on the grounds of local opposition. This move has been criticised by Dr David Kerr, the man responsible for the plan to centralise A&E units across Scotland in centres of excellence, as "sentimental, emotional and irrational". Who is right?

Dr Kerr's original strategy document, published in 2005, expresses the dilemma clearly: "Patients and the general public told us at our open meetings that they wanted services delivered locally ... They have lost ... confidence in the NHS due to what they perceive as unnecessary "creeping" centralisation driven by what is convenient rather than what patients need."

This distrust remains, and the SNP is responding to it. On the other hand, there is a genuine case for centres of medical excellence. And merely freezing the current NHS restructuring in midstream - the essence of yesterday's announcement - will only result in the worst of both worlds. The solution is a calm rethink rather than piecemeal reaction. A mix of community casualty departments and centres of excellence could be the answer - as originally suggested by Dr Kerr. Above all, the public has to be more involved or NHS reform will become an impossibility.