Health economics may be misleading

EDITOR—Posnett in his article asserts that “a close observer of the NHS… might be forgiven for thinking that the debate about the concentration of acute hospital services has been driven more by the needs of NHS managers and the medical professions than by the needs of the local populations that they are supposed to serve.”1 As director of the York Health Economics Consortium, he explains that the apparent logic of rationalisation and mergers is not supported by the evidence. He argues that service planners would do well to give more prominence to the importance of ensuring that hospital services are local and easily accessible.

Fine words, but what about the rationalisation in Liverpool that followed the consortium's recommendations in 1992? In their review of accident and emergency and related acute services for …