When we discuss (in chapter 4) the location of a manufacturing plant or a service operation, we tend to talk in rational terms about factors such as transport links, access to resources, communication links, pedestrian footfall or traffic flow, and availability of land. But in some types of operation, notably those providing essential services such as fire and rescue, education, or medical services, the location decision is heavily influenced by social and political pressures. In simple terms, people expect these facilities to be located in close to proximity to where they live, whatever ever the economic or operational case for not doing so.
A recent example of this is the debate as to where to locate Accident and Emergency (A&E) units in England. About this time last year, Sir Bruce Keogh, the National Medical Director of NHS England, published a report that proposed improvements to the provision of urgent and emergency care. One of the key proposals was that two types of A&E unit be set up – Emergency Centres which would remain local, and 40 to 70 Major Emergency Centres, which would be strategically located in regions. The rationale for the Major Centres is that they would have a critical mass of equipment and expertise, and be better able to treat the more serious cases.
But according to recent report in The Guardian this is not going to happen. And it seems that the main rationale for this decision is the electoral backlash the government might experience, if it was perceived to be downgrading the provision of services in local A&E units.