18 February 2014

The average distances between patients’ homes and the hospitals in which they receive emergency care have barely changed for a decade, new research reveals today.

But proposed changes to A&Es in England could mean that, without careful planning, some patients in remote areas may have to receive the appropriate emergency care further from home – although these changes could result in potentially better quality of care and patient outcomes.

The research examines over a decade’s worth of data to provide the first assessment of how the distance from home to hospital has changed for patients needing emergency care.

It is published alongside a set of interactive maps tracing home-to-hospital distances over time by the Nuffield Trust and the Health Foundation as part of QualityWatch, a research programme examining the quality of patient care in England.

The study finds that despite the total number of emergency admissions rising by over a third in ten years, the average distance from home to hospital has only increased by 0.2 miles.

In most cases these distances are not large: in 70% of cases, emergency admissions happened within 6.2 miles (10km) of a patient’s home, and only 3% of people were admitted to a hospital more than 18.6 miles (30km) from home. But the research did show that people in some rural areas have to travel over ten times as far as those in urban areas.

For example, in West Somerset average home-to-hospital distances were 18.5 miles compared to just 1.6 miles in Camden, reflecting the differences in population density in these areas.

The research also reveals that changes in services can significantly change distances to emergency care. For example, after the A&E Department at Burnley General Hospital closed in 2007, the average distance for an emergency admission in Burnley District rose from 3.2 miles in 2006/07 to 8.7 miles in 2008/09.

In the adjacent Pendle District, average distances rose from 5.2 miles to 10.8 miles during the same period. By contrast, when the new Maidstone Emergency Care Centre opened in Kent, average distances fell by 66% from 15.7 miles in 2004/05 to 5.3 miles in 2005/06.

The recent NHS England review into urgent care recommended fewer and better-equipped major A&E departments for the most serious cases. The Nuffield Trust and Health Foundation believe that this could potentially lead to better health outcomes for patients but service planners will need to balance the benefits of increased specialisation against increased distance to emergency services.

Commenting on the research, Nuffield Trust Senior Research Analyst and report author Adam Roberts said:

“There is understandably a high level of attention on the provision of emergency care and our research provides us with the first picture of the distances from home to emergency care against which we can assess change.

“However, despite concerns around major A&E departments being closed or downgraded, our analysis shows that the average home-to-hospital distance for patients who receive emergency care has remained remarkably stable over the past decade.

“In the future, designating 40-70 major A&E departments, as recommended in Sir Bruce Keogh’s review, would likely result in an increase in home to hospital distances for some patients.

“If this resulted in a better standard of care upon arrival this could lead to better outcomes, as the recent reconfiguration of stroke services in London shows. But careful planning will be needed to ensure that this does not adversely impact patients in rural areas where the distances involved are much greater.”

Chief Executive of the Health Foundation, Dr Jennifer Dixon, comments:

“Our QualityWatch report indicates marginal increases in the distances travelled by patients to access emergency services over the last decade. However this may change following NHS England’s review of urgent care: service planners will need to balance any extra travel times and distances that may result with potential benefits from having better staffed services with a larger range of experts available.”

Notes to Editors

  • The QualityWatch research examined emergency admissions in England between 2001/02 and 2011/12, focusing on the average distance from a patient’s home to the nearest emergency centre. It examines a number of case studies to identify the variation in distances travelled before and after reorganisation.
  • The research is published alongside a set of interactive maps which allow users to compare home-to-hospital distances over time in the local authorities in England.
  • While the analysis looks at the distances from home-to-hospital for emergency care it has not explored the outcomes associated with longer travel distances, so it does not suggest that this may lead to adverse outcomes.
  • QualityWatch is a major research programme from the Nuffield Trust and the Health Foundation that aims to provide independent scrutiny into how the quality of health and social care is changing over time. It was launched in October 2013. The programme published its first annual assessment of the quality of care in England on 10 October 2013.

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