EMERGENCY medicine experts have backed the call by a health chief for more centralisation of accident and emergency departments and potential hospital closures, to help fund more care in the community.

Andrew Robertson, outgoing chairman of NHS Greater Glasgow and Clyde, said politicians needed to take tough decisions otherwise hospitals would be unable to manage while services in the community would remain underfunded.

He cited Glasgow's controversial Queen Elizabeth University Hospital (QEUH) as a model as it has centralised A&E provision while other services in the city have closed. He also said other funding of community-based initiatives would remain piecemeal unless leaders were willing to "close acute service units and reinvest the proceeds".

Tim Parke, a consultant at the hospital's A&E department tweeted support for the view and said he would not go back to five separate A&E departments, adding that despite teething troubles, the service at the QEUH was now vastly better than before.

"People are being seen more quickly by more senior people, the A&E wards are better and there is better access to services such as radiology, stroke care and vascular care," he said. "We are not where we want to be yet with A&E waiting times, but they are way better than last year."

Both NHS managers and the public should watch the Glasgow example of what happens when you do close and merge hospitals, he said.

"You can't have a project that big without some problems, but people can judge for themselves whether the model of creating super-hospitals is a success," he said.

"It is clear that the flow is not right yet, but despite the teething troubles at the QE, there is no way I would go back to the five old overcrowded understaffed A&Es in Glasgow."

Martin McKechnie, vice chairman of the Royal College of Emergency Medicine in Scotland, said there needed to be a public conversation about how services are configured in the future.

"There are lots of good examples which show that if you centralise expertise, people do things better because they do them a lot and the outcomes are better. This is for the benefit of patients," he said.

Mr McKechnie also said Glasgow's super-hospital needed time to prove itself, and praised the Scottish Government for investing in more consultants. But he said social care also needed investment.

"The QEUH will take time to settle down. But to improve the flow of patients through emergency medicine departments, we have to provide better social care in the community for patients.

"There are people in acute beds who would be better served in another setting: coming to an A&E is not in their best interests," he said.

Ranald Mair, chief executive of Scottish Care, which represents independent home care and care-at-home providers, said the health service had largely been protective of hospital provision as he described Mr Robertson's comments had been 'brave'.

"There are people in the health service who favour greater centralisation, but most politicians see hospital closures of any sort as a vote loser," he said.

"However if you are serious about wanting investment in health and social care in the community, you may have to rationalise other services."

A government pledge to deliver fair pay for staff in care services was welcome, Mr Mair said, but had to be fully costed, or there would be no resources to invest in new services.

"We will only cope with rising demand if we have alternatives to hospitals consuming larger portions of money which we need to invest in community capacity. That burden can't be shouldered by the acute sector and politicians need to square that circle."