Comment: We should keep A&Es

When it comes to medicine, change is inevitable. Medical practice doesn't stay the same and public expectations shift so there will always be a need to keep moving and reviewing how the health services are provided.

I was invited to West Sussex to look at the Fit for the Future proposals.

I accepted the role of independent assessor because I wanted to ensure health services are safe for patients and built to last.

Based in Scotland but living for much of the week in London, I am somewhat distanced from the West Sussex area but felt this gave me an advantage.

I was able to give a completely dispassionate view and recommendations based on what is best for patients, not politics.

The disadvantage is that I don't know the intricacies of the health services in West Sussex.

That is why final decisions must be taken by the primary care trust (PCT), a group of health leaders in the local area who know the patch much better than I do.

I had three tasks. One was to look at the options that went out for formal consultation last summer.

The second was to encourage people to come forward with other proposals that may meet the "must-do criteria" of ensuring health services are deliverable, clinically safe and can be afforded, not just now but into the future.

My third task was to see if there might be a consensus around additional proposals that would meet with the approval of the public and clinicians.

It has been a busy four months and, after speaking to many individuals, I feel confident the recommendations I have made to the board of West Sussex PCT ensure health services remain safe for patients and can be sustained for some time to come.

The health service is a personal service so it needs to listen very carefully to what the public want and expect. But people also need to understand that medicine does not stand still.

We must all take into account the changes in medical practice and advances in technology, and we must adapt our health service accordingly.

For example, doctors work fewer hours than they used to - and so they should. Seventy-hour weeks are not acceptable and it is not good for patients to be treated by tired doctors.

Public expectations are also higher. Patients no longer expect to wait for treatment and they also want a choice of treatment. When they are treated, they want the best drugs and life-saving equipment available.

During the course of the consultation and throughout my discussions there was overwhelming support for retaining emergency services.

There is also, I believe, a recognition that changes need to happen.

Naturally, patients want the best from their health service but we also need to ensure we can afford it and that the service offers the best value for money.

I don't necessarily see these two things as being in conflict and my hope is that we will not be closing A&E departments at any of the existing hospitals.

Maintaining three A&E services at the existing hospitals, backed up by services that support emergency medicine such as intensive care and 24-hour X-ray, was what the public wanted and was proposed as an option by clinicians.

I personally agree this is possible for West Sussex and support this recommendation.

Some changes, however, are necessary to maintain safety and meet national best practice. Local needs and maternity services fall into that category.

I have recommended that maternity services are centralised on one major general hospital site supported by high-quality paediatric services, such as children's in-patient services and emergency services, with midwife-led units on other sites.

This plan for services will ensure a good, high-quality and safe maternity service for women and babies across the county.

While I appreciate that some people may have concerns about this model, the change will apply during the birthing stage and affect women identified as high risk.

The care before and after giving birth will continue to be delivered locally, as at present.

Looking to the future, I believe this plan will be the best and safest service for pregnant women and their babies.

During my time in West Sussex I have also looked again at options that were previously rejected but for which substantial support was shown through the consultation process.

A new hospital in the northeast of the county was one of the rejected options I discussed with people from the Crawley and Horsham area.

I ruled out a new hospital facility in my recommendations but I did propose a review of health services in this area.

I am pleased the PCT has acknowledged this need and asked me to chair this important piece of work.

The review will not be constrained by NHS and county boundaries and will cover the area I call the "Gatwick Diamond", which stretches across the border into Surrey.

As I have said previously, the health service cannot stand still.

If people want the best and the safest service possible - one that helps people to live longer and lead happier and healthier lives - then we must move with the times.

Healthcare is being delivered in new and innovative ways. Patients are having MRI scans and minor surgery in healthcare centres close to their homes.

Many years ago, a patient would travel for miles and wait for hours to attend a five-minute appointment for something as simple as a blood test, which could so easily be done in their GP surgery.

Thousands of people are also being treated in their own homes.

This would not have been possible only a few years ago but this change has helped transform people's lives.

My motivation in coming to West Sussex was to help improve services for patients and to make sure they have the best and safest service possible which will last for years to come.

I believe my recommendations will ensure this for the people of West Sussex.

It is now up to the board of the West Sussex PCT to examine my recommendations and determine the best way forward.

Do you agree with Sir Graeme?