Centralisation of services is politically impossible

To find the royal colleges proposing that acute inpatient care in the United Kingdom should be provided in fewer, larger, better equipped, and better staffed hospitals is not unusual. What would be unusual would be to find a government two years out from a general election rushing to implement such advice. The Senate of Surgery of Great Britain (comprising the four surgical royal colleges, the dental faculties, and 10 surgical specialty associations) has published a policy paper that seeks to speak with a single voice for the surgical community (www.rcpsg.ac.uk/recreport.htm).1 This policy paper signals a wish for a debate on this controversial topic and a wish to participate.

These surgeons want a lot—and not for the first time, and not just the surgeons. The senate suggested something similar in 1997, but it did not happen.2 The Royal College of Physicians wants to phase out acute emergency admissions from isolated smaller units and transfer the work to properly equipped and staffed larger units.3 The arguments …