Realistically, within 5 years, Stafford A&E & ITU will be closed completely and replaced with a Minor Injuries Unit (MIU) and Medical Assessment Unit (MAU) that will accept GP Referrals. Hopefully any MIU would be doctor-led, open 24/7 and able to treat minor fractures, eye injuries, intoxicated youths and perform wound closure etc.
Minor injuries and illnesses will continue to be treated on site, intermediate health problems will be assessed by the [OOH] GP, who will arrange admission to MAU if inpatient care is required and 'serious' health problems will be taken directly to North Staffs Hospital for advanced assessment and treatment from a Consultant led team, whatever the time of day.
Stafford Hospital will probably gain a few 'step down' units, where patients from the local area who have been admitted to North Staffs Hospital with serious injuries/illness can be transferred closer to home once their condition begins to improve.
Ambulance crews have been bypassing Stafford A&E for a number of years with any patient who is suffering a heart attack, stroke or major trauma, as North Staffs Hospital has 24/7 specialist units available for these patients which offer a substantially improved survival rate compared to a local DGH such as Stafford.
Stafford A&E does not see enough critically ill patients to justify 24/7 Consultant cover, and numerous studies have shown that Consultant led emergency care substantially improves survival rates for patients with serious injuries/illness, so in the long term, Stafford and similar sized non specialist hospitals will not be able to justify offering A&E services.
Ambulance Paramedics are now degree trained, highly specialist and can offer the majority of lifesaving drugs and interventions that a middle grade doctor can perform in a small A&E such as Stafford. Given that they are already bypassing Stafford A&E for heart attacks, strokes and major trauma, it would not be a big jump to take all seriously ill patients to North Staffs. The few interventions that paramedics are unable to offer such as RSI (emergency anaesthetic) and certain surgical procedures are likely to be taught to experienced Paramedics known as Critical Care Practitioners who will be dispatched to serious calls (or requested by the crew on scene) in order to provide advanced care whilst en route to North Staffs.
Given the massively improved mortality and morbidity rates for patients taken directly to a large specialist hospital such as North Staffs, I cannot see why anybody would want Stafford A&E to stay open in its current form.
That said, I do think it's important for a 24/7 MIU and MAU to remain open to cater for patients with less serious injuries/illnesses such as elderly residents who needs a short hospital admission to recover from chest &/or urine infections. I see no reason why the hospital couldn't continue to offer planned surgical, outpatients and maternity services in this new type of setup. The closure of ITU would mean that any patients who require more specialist care than that offered on HDU (High Dependency Unit) following an operation/planned admission, would need to be transferred elsewhere.