Eighth principle in reconfiguring acute hospital services

EDITOR—Smith describes the seven principles that should be followed when reconfiguring acute hospital services.1

There is an eighth principle, most important of all for economy—that no condition manageable in a spoke should ever progress to or remain in a hub. This entails bottom up rather than top down planning. Ninety per cent of all contacts are handled in primary care and 50% of inpatients and 90% of “casualties” can be managed in minor injury units. Trauma centres and super-specialist units are the way ahead for a minority of patients. The majority must be prevented at all costs (sic) from entering them.