Appendix X: PEST and SWOT Analysis
POLICY AND POLITICS
Forces and drivers for change
Guidance from the Royal College of Surgeons of England, the Royal College of Physicians of London, the British Association for Emergency Medicine, the Faculty of Accident & Emergency Medicine of the Royal College of Surgeons in England and the Academy of Medical Royal Colleges that: • • • • • • • • Emergency surgical services should be organised for a population of 450500,000 The provision of comprehensive elective surgical care on a stand alone basis by a DGH is not sustainable and should be replaced by a network of hospitals serving populations of 500-600,000 The ideal unit for fully comprehensive medicine and surgery is a hospital or group of hospitals serving a population of 450-500,000 The lowest catchment population for ‘district hospitals’ providing 24 hour children’s services, 24 hour surgical services and maternity services as well as acute medicine and surgery is 250,000 ‘local hospitals’ serving a population less than 250,000 are unlikely to be able to sustain 24 hour/emergency surgery or inpatient paediatrics or consultant led obstetrics and may have to operate a ‘selected medical take’ There should be no single handed consultants in any major subspeciality Smaller A&E units seeing less than 40,000 new patients per annum should be supported where they are able to demonstrate their effectiveness, safety and quality and where they serve geographically isolated populations The above changes will be triggered by a lack of medical manpower following on from the introduction of the EWTD.
West Midlands SHA has identified that paediatrics, maternity, A&E and emergency surgical services within the region are ‘challenged’ (Investing for Health Chapter 6) DoH policy emphasising the shift towards greater levels of care being provided by primary and community care providers or in a community setting... [continues]
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