Emergency care – far from home?

Adam Roberts, Nuffield Trust, explores how the distance from home to urgent care has changed.

Blog post

Published: 18/02/2014

Any change to the location of hospital care will attract public and media attention, especially when it involves the closure or downgrading of a hospital or A&E department. But with health systems feeling the financial squeeze the search for savings may require more reconfiguration of services.

Although it is often discussed, there is little information about how far away emergency services actually are from where people live in England, how these distances vary across the country and whether they are changing. In our new report we aim to answer these questions.

Spoiler alert! In short, there are no real surprises.

Firstly, the distance generally isn’t that far. The majority of people who attended a major A&E in 2011/12 were able to do so within 2.6 miles (4.2km) of their home. Even in more serious cases requiring an emergency admission to hospital, most occurred within 3.4 miles (5.5km) of the person’s home, and 70 per cent were within 6.2 miles (10km).

To put that in context, we travel an average distance of 7 miles (11.3km) for a normal journey to work, school or shopping etc (Department for Transport 2011).

Secondly, the distance from home to hospital for an emergency admission varies across the country. This shouldn’t come as a surprise; if you live in the middle of a densely populated city, it is reasonable to expect that you will have a hospital close-by.

Conversely, if you can only see one other building from your home, you wouldn’t expect it to be a hospital. That isn’t to say that your personal need is less important than that of someone living in a city, just that there is a higher level of need where there are more people.

The NHS has limited resources and must spend them in the most effective way; hospitals are expensive, so it’s appropriate to position them where they will support the most people.

However, in parts of the country where the distances are much greater, the question of distance may carry more weight when considering any reconfiguration.

Finally, the average distance to hospital has not substantially changed over the last decade, rising by less than a quarter of a mile, from 5.2 miles to 5.4 miles. One of the surprises from this work is how difficult it was to get a clear picture of where NHS emergency services have opened or closed in recent years; but data provided by Binleys suggests that the number of A&E departments in England has stayed fairly stable since 2006.

So what does our research mean for the wider debate on A&E closures?

Obviously, when an A&E department does close there will be an impact on the distances for people living nearby. But the opposite is true when an A&E department is opened.

The question of how far is too far for emergency care is a complicated one. Generally, receiving treatment quickly following an accident is preferable. But there are many cases, such as stroke or serious trauma, where there is a significant benefit from travelling further to reach a specialist centre. Clearly there is a balance to be achieved between providing ease of access and over-supplying an inefficient service.

There is no doubt that changes or closures to A&E services are a hot topic at the moment – and that looks set to continue. But like many debates in healthcare, this one is sadly not fully informed by the evidence. This is hardly surprising: the evidence on distances for emergency care, or even where services have moved or closed, has been sorely lacking.

While we do not claim that this research fully informs the impact of A&E closures debate, it does provide empirical evidence on the true picture of the distances involved, both currently and over the last decade. Time will tell whether there will be a dramatic increase in these distances over the next decade.