Reconfiguration of surgical, emergency, and trauma services

Editor—Black's editorial on the reconfiguration of surgical, emergency, and trauma services in the United Kingdom discusses what is proving to be a destructive tendency in Scottish medicine and, I suspect, in UK medicine.¹

A depressing trend prevails in Scotland to see centralisation (sometimes euphemistically described as creating “managed clinical networks”) as a reasonable solution to all the ills that currently afflict us. These include the new deal, the consultants' contract, the general practitioners' contract, the European Working Time Directive—all man-made artefacts and all preoccupied with the welfare of doctors, not patients.

A view dominates that unless something can be done to the standard of the Mayo Clinic it should not be done at all. This endangers our small and not so small district hospitals and our specialist services in the regions of Scotland and ultimately leads to the absurd conclusion that we have only one or two hospitals.

We should instead be looking at how we can improve medical services where our people live. We have to do this to encourage the survival and the development of our regional and rural cultures. Fewer and bigger hospitals are certainly not the answer. Other European countries recognise that, and I expect that our electorate will as well. If they don't some of us will be sure to tell them.