Reconfiguration of surgical, emergency, and trauma services

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