One in 10 accident and emergency departments has either closed recently or could shut in the near future, while a similar proportion of labour wards is at risk.

Health campaigners fear that the lives of people who live far from remaining hospitals or departments will be put at risk, particularly those in rural areas. They are also worried that single department closures will lead to a ?domino effect?, causing other specialties to tumble, and eventually affect the whole hospital.

Given the state of Britain?s finances and the enormous size of the NHS budget ? more than ?100 billion a year ? campaigners are concerned that ?reconfiguration? could be a ?smokescreen? for cuts.

The Daily Telegraph has found that 25 A&Es ? 10 per cent of the total ? have either closed recently or could be shut or downgraded under existing plans. There are recent or planned changes to close or downgrade consultant-led maternity wards at 18 hospitals, accounting for about one in nine departments throughout England.

And some 11 paediatric wards have shut or face the threat of closure, out of about 175.

In Northallerton, North Yorks, campaigners have been objecting to plans to downgrade a labour ward to a midwifery-led unit, and to proposals to shut the inpatient paediatric facility at Friarage Hospital.

David Williamson, a nurse and spokesman for the local campaign, said: ?We fear being further from hospital. These reconfigurations put people in rural areas at greater risk.?

If children?s services were downgraded a ?domino effect? could result, he said. ?People fear that eventually the whole hospital could go, that it will be death by many cuts,? he added. A hospital spokesman said no decision had yet been taken.

In Gateshead, the Queen Elizabeth Hospital is soon to stop providing inpatient care to children, while there will also be no overnight emergency care.

Dr Helen Murrell, a local GP, said: ?The consultation has been a sham. I have no doubt that this is a disaster, I am sure children will die because they will have to travel further.? She argued that the changes were principally driven by a desire to save money, a charge rejected by the hospital trust.

Meanwhile, north-west London is in the midst of a major reorganisation that could see four of nine A&Es closed, at Hammersmith, Charing Cross, Ealing and Central Middlesex hospitals. Dr Mansoor Bhatti, a consultant gastroenterologist, argued that these closures would ?jeopardise a fundamental principle of emergency care? ? that most A&E patients would be seen within an hour. Concerns have also been raised that the remaining A&Es will struggle to cope with demand.

Katherine Murphy, chief executive of the Patients Association, said: ?I totally appreciate that concept of centralising services, but you can?t jeopardise lives elsewhere.? She also feared that there would be financial pressure to diminish investments in remaining hospitals.

Peter Carter, chief executive and general secretary of the Royal College of Nursing, said the institution would support reconfiguration providing the plans did not represent a ?short-term, ill-thought-out closure to save money?.

The other medical colleges are broadly in favour of centralisation. The Royal College of Physicians is leading a major review which could call for large numbers of hospitals to be closed.

Senior figures say that the point of centralisation was to ensure better care.

Many hospitals struggle to fill night and weekend rotas, leading to death rates that are, on average, 10 per cent higher than during the week. Mike Farrar, chairman of the NHS Confederation, which represents managers, said heart attack survival rates had risen by 20 per cent in east Lancashire after A&E centralisation.

Dr Chris Roseveare, president of the Society for Acute Medicine, said smaller facilities struggle to provide a seven-day service, but added: ?We?d be concerned if reconfiguration was a smokescreen for cuts in service overall?.

A Department of Health spokesman said: ?We have put doctors and other healthcare professionals at the heart of ensuring that patients receive the very best and safest care in the right place.?

A spokesman for NHS North West London said its proposals ?will save hundreds of lives? through ?better care?.

Source The Telegraph

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