Reconfiguration of surgical, emergency, and trauma services: Bigger is not better

doi:10.1136/bmj.328.7438.522-b

BMJ 2004;328:522 (28 February), doi:10.1136/bmj.328.7438.522-b

Letter

Reconfiguration of surgical, emergency, and trauma services

Bigger is not better

The first 150 words of the full text of this article appear below.

EDITOR—Black's editorial on the reconfiguration of surgical,emergency, and trauma services in the United Kingdom discusseswhat is proving to be a destructive tendency in Scottish medicineand, I suspect, in UK medicine.¹

A depressing trend prevails in Scotland to see centralisation(sometimes euphemistically described as creating "managed clinicalnetworks") as a reasonable solution to all the ills that currentlyafflict us. These include the new deal, the consultants' contract,the general practitioners' contract, the European Working TimeDirective—all man-made artefacts and all preoccupied withthe welfare of doctors, not patients.

A view dominates that unless something can be done to the standardof the Mayo Clinic it should not be done at all. This endangersour small and not so small district hospitals and our specialistservices in the regions of Scotland and ultimately leads tothe absurd conclusion that we have only one or two hospitals.

. . . [Full text of this article]

David G Currie, neurosurgeon

Aberdeen Royal Infirmary, Aberdeen AB25 2ZN David.Currie@arh.grampian.scot.nhs.uk