The prime reason given by the Royal College of Surgeons and the BMA for merging so as to obtain catchment populations of upwards of 500,000 is that otherwise it is not possible to provide continuous consultant cover, and thus safe emergency services, 24 hours a day, every day of the year. It is better - measured in terms of survival - for patients with life- threatening conditions to be transported a few more miles into the hands of top-class experts than to have the convenience of proximity, but thinly spread skills.
The second issue is that the very technological developments that make it vital to centralise emergency care also allow the great majority of non-emergency cases to be treated away from the central hospital. Rather than closing local hospitals, they can be developed in a new role to include specialist outpatient clinics, minor casualty units, radiology and physiotherapy departments, maternity units for normal births and facilities to deal with the elective surgical work which makes up waiting lists.
So rather than most patients having to travel farther (except for emergency care of life-threatening conditions) locality hospitals can bring most of the functions for which most people have to go to hospital much closer to where they live.
Dr RONNIE POLLOCK
MPA Health Strategy and Planning