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LETTERS: David G Currie Reconfiguration of surgical, emergency, and trauma services: Bigger is not better BMJ 2004; 328: 522-b [Full text]

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Bigger is better

Sam Galbraith   (2 March 2004)

Bigger is better 2 March 2004
Sam Galbraith, Research fellow University of Glasgow G12 8RZ Send response to journal: Re: Bigger is better	There are a number of reasons for centralising services well outlined in David Currie's letter. But the main reason is to improve patient care. It is not a new phenomenon. Many specialties over the years have become centralised including your correspondent,s own of neurosurgery. something with which he would agree. The main impetus behind behind the current reconfiguration is the growing evidence of the relationship between volume and outcome; the larger the number of proceedures the better the outcome,well seen again in Neurosurgery. Doctors ignore this or dismiss it at their peril. Of course history and geography have to be taken into account when considering services, and they are. It is not true that the choice is between centralisation or nothing. Managed clinical networks allow some services to be retained in the district hospitals and as such act to prevent centralisation, not as your correspondent suggests to promote it. Their is much that can be done to preserve some services As I know from my time as a Health Minister, closing a hospital is never easy . Doctors who oppose a closure should be clear of the evidence on which they base their case.If they simply appeal to culture and emotion they are in danger of denying patients the best possible medical treatment. Unlike your correspondent I do aspire to the highest standards of the Mayo Clinic. We should accept nothing less for our patients. Competing interests: None declared