Closing down half the country’s Accident & Emergency units would be an easy decision for Gordon Brown the Chancellor of the Exchequer. Whether Gordon Brown the Prime Minister will be so enthusiastic remains to be seen.
At present, the average A&E department covers 250,000 people. The money-saving closures proposed by the Department of Health will increase that to about 450,000 people. The cuts are not, of course, presented as money-saving nor, indeed as “cuts” at all. They are a “rationalisation”, an assessment as to what size catchment area is “viable”.
We are slap in the area predicted recently by Matthew Parris in the Times – a Chancellor who has spent a decade describing all expenditure as “investment” has a problem of terminology when all the money has been wasted – sorry, invested – and runs out. What do you call it when it becomes necessary not merely to curtail “investment” but to make savage cuts to public services? “Investment” does not really have a relevant antonym – “divestment” equates to “selling up” and you need to sell the whole hospital to capitalise on the “investment”.
It was easy for Gordon Brown the Chancellor. Tony Blair would lie and charm and dissimulate his way through PMQs. Patricia “Useless” Hewitt would do her Chemical Ali impression and tell the public of the enormous benefits to be derived from having to drive twice as far with a bleeding child or with an aged relative who has turned blue. The Chancellor of the Exchequer would be mysteriously absent when the subject was raised.
Gordon Brown the Prime Minister cannot do that. When Blair has limped off the stage, and the disposable Patricia Hewitt has had her well-deserved bullet, it is Brown who will have to face the music. The clunking great fist and the usual torrent of meaningless statistics will not wash with a public which has to wait in A&E for hours as it is, which has no reliable form of public transport, and which, in some areas, is unlikely to see an ambulance in time because the ambulance service too will have been “rationalised”.
There will be some amusement to be derived from watching Brown attempt simultaneously to boast of improved public services and cut A&E – some amusement for me, anyway, because I live very close to an A&E which will not close and have someone to drive me there. I may have to wait several hours once I get there, but I will be ahead in the queue of the person who has been driven 60 miles to get there, and I can be reasonably sure that they won’t let me die on the premises without someone having a look at me.