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There is a misconception that the benefits seen with centralising stroke/trauma/primary angioplasty apply to all other acute medical emergencies . There is good evidence that rapid access ( journey time) is perhpas more important for survival in conditons such as respiratory distress from pneumonia or septicaemia. There is a misconception that most frail elerly people are rushed into hospital for social care. In fact the more frail they are, the more likely they are to develop sepsis, diffiuclty breathing, chest pains , loss of consciousness, delirium,fractures etc etc none of which can be easily treated in the "community" ( no fast acces to Xrays, bloods,IV, blood gases, drugs, medics etc). It is true discharges need to be sped up from hospital - but by closing a third of the hospitals, the main users of our acute services( the over 70s) will have to travel much further for secondary acute medical care to a tertiary centre instead- and probably clog up beds and make access even more difficult for those genuinely needing teritiary care?The elderly and the frail have a right to expect access to necessary treatment ?The sheer numbers of patients who will then flood the tertiary centres are likely to make the workload and capacity unmanageable without major expansion/build of wards in these tertiary centres? The Bristol reconfiguration is a good example to look at.