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When I worked in specialised commissioning, we had a large number of medically led evidence based debates with external peer reviews regarding the whole quality versus access debate. There are clearly a number of services where it isn't the case that the more you do, the better you are, because activity's inversely proportional to outcome - there's a greater correlation between outcome and say infection control or ratios of nurses to patients in high dependency units. There are other procedures where there is a correlation - you become safer the more practised you are. But what was interesting was how this changed over the 10 years I worked. Something once seen as routine became far more complex (e.g. upper GI surgery) because new techniques like laparoscopy meant you could do more things. And in turn, take on more complex patients. So the detail on what constitutes a good service for X isn't static. It's hard to work out all the factors that make provision A "better" than provision B, which is why you need to involve all the professions and a wide evidence base.