”Doctors back mass hospital closures” said the front page head-line of the Observer on 17 September. To many doctors this will have come as a surprise. This issue has never been the subject of a full national debate in the profession. Over the past 15 years there has been much talk of centralising services and many local campaigns over individual threatened local hospitals but little systematic collection of evidence to inform decision making. Instead, the process has been driven largely by financial pressures, by the European Working Time Directive and its effects on junior doctors' staffing, and various recommendations from the royal colleges about the levels of staffing and activity that would allow posts to be accredited for training.

Inevitably these pressures have driven hospitals to amalgamate services, at some cost to local accessibility. Equally inevitably such moves are deeply unpopular with patients, who may have to travel considerable distances for acute care that used to be on their doorstep. The services most likely to be cut or merged throughout Britain are paediatrics, obstetrics, and …