THE crisis in A&E departments is increasingly a national as well as a local story.
Politically, it's uncomfortable for both government and opposition.
The national shortage of A&E doctors, highlighted in last week's Echo, clearly has roots in workforce planning under Labour not just the last couple of years of the coalition. New health secretary Jeremy Hunt is right to look urgently at ways of increasing emergency recruitment. This should have been done years ago.
But did his predecessor Andrew Lansley make the situation even worse by planning the flawed new 111 out-of-hours service, contributing to a surge in emergency admissions? The national Keogh review is looking into problems in emergency care and may provide some answers.
Locally, long A&E waiting times at Cheltenham General and particularly Gloucestershire Royal Hospital in Gloucester have got the NHS Foundation Trust which runs both into trouble with the health regulator Monitor. As I write this column, the trust's website (see http://bit.ly/QzoTAf) tells me that the waiting time at Gloucestershire Royal is over three hours, more than double the wait in Cheltenham. Yet Cheltenham is the one facing closure to ambulances at night.
So as the local decision-making process moves on, can the local trust claim the planned downgrade just reflects a national crisis? I don't think so. Tomorrow the county's Health Overview and Scrutiny Committee gives local councillors a say.
Here are just some of the questions they should ask:
1. Shouldn't we wait for the various urgent national reviews of issues like recruitment before permanently downgrading Cheltenham?
2. How hard have the trust really tried to recruit more emergency doctors? They have never taken advantage of the freedom they have as a foundation trust to offer higher pay, for instance.
3. Have they even calculated the increased mortality that will result from closing Cheltenham A&E to ambulances at night? One academic study suggests that the increased travel time leads to a significant, measurable increase in deaths. This trust has never mentioned this.
If you're still as concerned as I am, sign my petition at http://www.surveymonkey.com/s/6FBMKLJ or call 224889 for a paper copy.