IF THE pattern at hospital accident and emergency departments up and down the country is, as a survey shows, one of them struggling to cope with soaring patient demand and staff shortages, just what are we to make of a remedy that involves shutting lots of them down?

Yet, amazingly, this is an idea being put forward by the public spending watchdog, the Audit Commission, after running its rule over casualty departments and finding them creaking under the strain.

To them, this grim situation adds charm to the arguments that larger departments deliver better care.

And, so, under the microscope go all the smaller ones within 10 miles of each others, with potential mergers in view - which could result in the closure of more than 30 casualty departments in England and Wales.

Already, one upshot is a secret hit list of the ones that might be axed, including those serving the population of the western and eastern fringes of our area - at the Royal Preston Hospital, at Chorley, and at the Airedale General Hospital.

It goes without saying that any such proposals will run into a hail of local opposition.

And rightly so.

For this notion - for all the "costing" that has yet to be done of casualty departments' waiting times, staff shortages, consultant cover and so on - has nothing to do with responding to patient demand with improved resources.

Rather, it is all about concentrating already-insufficient resources in fewer locations - to the greater risk to and inconvenience of patients who must travel further - ignoring the glaring need for extra investment in accident and emergency services; above all, for more doctors and nurses.

This merge-and-close notion is an "accountant's solution" that does nothing to diminish patient hardship - and may only increase it. And this cheapskate, risky, eggs-in-one-basket idea is, we think, full of dangers should a disaster or large-scale emergency ever be visited on a community that has had its casualty services "improved" by them being removed to a hospital some 10 miles away - a risk that the tragic events in Dunblane last week make us all the more aware of.

Rather than this, real solutions are needed - more doctors and nurses for casualty; action to make accident and emergency less of a Cinderella speciality; and an ending of the nonsense whereby junior doctors, planning a career in surgery, can actually omit crucial experience of casualty work from their training.

And if reducing the accident and emergency workload is also a consideration, then, the Department of Health and NHS hospital trusts ought to be allowed to charge the full fees to patients who burden casualty department with non-emergency and frivolous cases.

Converted for the new archive on 14 July 2000. Some images and formatting may have been lost in the conversion.