## Accessibility and A&E

A&E is short for “accident and emergency” units, hospital units which provide critical services in health care. They need to be “accessible” by everyone in the community which they serve. What happens if an A&E unit is relocated?

Suppose we have three destinations A, B and C as shown in figure 1. B is connected to both A and C, although C is more accessible since it is closer.

Suppose also that B is an accident and emergency (A&E) unit in the UK, and that someone decides, on the grounds of hospital efficiency, to relocate it to B2 (figure 2). Here, B2 is still connected to A and C, but since the distances B2-A and B2-C have increased, both A and C have become less accessible. If you live in A and have an accident after the A&E unit has been relocated, your chance of timely medical assistance has gone down. It will take you more time to get to the A&E.

If the A&E unit is moved to B2 then people living in A and C will all take more time to travel to the relocated A&E unit. In the cost/benefit analysis of new road projects, one financial benefit is the value in money of the saving in travel times of people who will use the new road. Arguably therefore, the cost savings to the health authority in relocating the A&E unit should be discounted by the cost increases to patients and visitors which arise from their increased travel times.

Of course in theory, moving the A&E unit away from A and C will probably move it towards other destinations (D,E ….), so some people will have a reduced travel distance. If we know how many people live in A and C (and D, E….), and how long it takes to travel from A and C (and D, E….) to B2 then we can calculate the change in total accessibility of moving the A&E unit.

A good tool for this sort of calculation would be a Geographical Information System (GIS). Indeed, GIS is already being used for accessibility studies in countries such as Nepal (see e.g. ref. 775).

However if the health authority’s plan is to reduce the number of A&E units (rather than relocate some of them), then we could argue there will be a total, travel cost increase to its “customers”, even without a GIS analysis.

References

775 – Hare Ram Shrestha and Umesh K Shrestha, “District transport planning trend in Nepal”, International Conference on Sustainable Development of Transport System, 2011