The antagonistic reaction from University College London Hospitals trust to our alternative proposal for a 'millennium hospital' (News, page 7, 11 December) may be understandable - but it is not rational, and sadly smacks of 'I have made up my mind, don't confuse me with the facts' type of reasoning.
Your report also says that our proposals could destabilise existing hospital services. But the fact is that the historical pattern of acute hospital services is already unstable.
Both the British Medical Association and the Royal College of Surgeons have recognised that it is no longer possible to deliver effective emergency services with the existing pattern.
The main factor is the increasing complexity of medicine and technology, which has resulted in greater sub-specialisation, fewer junior doctors as a result of reductions in their hours, and changes in specialist training.
These all lead to the conclusion that effective emergency services need a greater aggregation of consultant staff, which in turn will mean centralising services to serve larger catchment populations of 500,000 or more.
The problem with centralisation of this order is that while it solves the problem of providing consultants, it also means that for many patients, services will be sited further away and be less accessible. Our model aims to overcome this problem, seeking to take advantage of technological advances and changing professional roles, and to permit the decentralisation of elective functions.
We propose that this is done by creating a network of locality hospitals as part of a single unified organisation, working 'hub and spoke' with the central hospital. Locality hospitals would serve a population of about 100,000, housing outpatients, minor injury services, imaging and rehabilitation departments.
They would have a small component of beds for low-risk maternity deliveries, for 'step-down' central hospital, and to support primary care.
A major function would be day surgery. The separation of the bulk of elective from emergency work, would enable a high level of predictability to be introduced into scheduling, and would facilitate the development of innovative new roles for nurses and other professional groups.
With this pattern, most patients would have the bulk of their hospital needs dealt with close to home.
When, for acute emergency conditions, a longer journey is necessary, it would be to receive immediate care at the hands of experts, with the prospect of better outcomes.
UCLH's chief executive says it would be silly to delay its plans. As any delay would be measurable in months, would it not be worse than 'silly' not to give proper scrutiny to forward-looking proposals which address a much wider range of issues, define sustainable new roles for threatened existing hospitals, and which set out a robust framework for future development at the same time as offering pounds1bn savings?
London Millennium Hospitals Ltd,