Video: A&E services: Sir Bruce Keogh defends two-tier proposal NHS medical director Professor Sir Bruce Keogh said the current system is under "intense, growing and unsustainable pressure" caused by increasing numbers of people turning to A&E, an ageing population and "confusion" over existing services. For those who do need to go to hospital for emergency treatment, he said two types of A&E should be created - emergency centres for assessing patients and starting treatment, and major emergency centres providing specialist care, such as for strokes or heart attacks. "It is about improving the outcomes for patients with very serious conditions - let me be absolutely clear, that two tier system already exists," he told BBC Breakfast. By serious conditions what I mean are trauma, heart attack, stroke, to name three of them. Ambulances already when they pick up somebody with major injuries take them to designated trauma centres, they already take people with heart attacks to specific designated heart attack centres and similarly for strokes. We have shown that when you do that, that despite initial concerns that the additional travel time would create problems, that the outcomes for patients are significantly better.