Parts of this report have been reproduced from Chambers et al.1 This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/. The text below includes minor additions and formatting changes to the original text.
The impact of reconfiguration of health services is important to commissioners, providers, patients and the public. Currently in the English NHS, programmes of service reconfiguration are being proposed at a local level by Sustainability and Transformation Partnerships, involving collaboration of all relevant stakeholders. Some of the proposed reconfigurations will increase travel time and/or distance for patients to reach their nearest hospital or other urgent and emergency care (UEC) facility.
Many communities value their local UEC services and perceive that planned or proposed changes could worsen outcomes for patients, particularly for those requiring emergency medical or obstetric care. Commissioners and service providers need evidence regarding the impacts of reconfiguration not only on patient outcomes, but also for the wider health-care system. For example, commissioners may have questions about effects on other provisions, such as ambulance and community-based services. Providers may face difficulties in staffing other services if they are no longer providing emergency care. A systematic review of evidence relating to outcomes for patients following service reconfigurations that change the time/distance to the nearest UEC facility is needed to examine whether or not the available evidence supports or refutes the belief that such reconfiguration is harmful. Furthermore, evidence on the broader relationships between distance to an emergency care facility, morbidity/mortality and health system outcomes is needed to inform evidence-based decision-making.
The recently completed closED study2 analysed data from five locations where emergency departments (EDs) were downgraded between 2009 and 2011. Although the authors found no evidence of an impact on mortality, despite patients having to travel further to access an emergency facility, there was evidence of an effect on the system, with the finding of an increased burden on emergency care providers. This systematic review will set the closED findings in the context of the wider international literature. A review of this topic will also contribute to evidence regarding the delivery of services in rural and coastal areas, which is a priority for the Health Services and Delivery Research (HSDR) programme.