The Royal College of Surgeons has demanded a major re-organisation of trauma services, while admitting there is no evidence this would be costeffective.

Just 27 hospitals in England, Wales and Northern Ireland would be accredited as top-level centres for severe injuries under the college's proposals for a national trauma service, unveiled last week.

Road accident victims would be taken straight to hospitals which met the college's standards, not the nearest accident and emergency department.

Launching a joint report with the British Orthopaedic Association, coauthor Professor John Templeton admitted there was no data to show regional trauma centres gave value for money.

Professor Templeton's hospital, North Staffordshire, pioneered the system in the early 1990s. But the report admits research found the West Midlands trauma system 'was not cost-effective.'

Professor Templeton, a senior orthopaedic surgeon, said the study 'only spanned three or four years' and was 'flawed' because it did not compare North Staffordshire with smaller district general hospitals. 'Our results show our death rate has dropped substantially, ' he said.

Hugh Phillips, president of the BOA, said the joint report's reccomendations would not involve 'huge costs'.

'The hospitals are already there. It is a question of identifying the best hospital for the patient, not the nearest.'

The national trauma service proposed by the report would be the equivalent of a national service framework, Mr Phillips added.

'The government has recognised that frameworks of care are important across the country, ' he said. The BOA and royal college had 'done the work' for the Department of Health 'at no extra cost'.

College president Barry Jackson said there was 'major concern' about the high levels of 'avoidable' death and disability from severe injuries, particularly in young people.

Mr Phillips said up to one-third of all deaths from major trauma were preventable, but there was 'no national coordination' of services for these patients.

The framework would be 'based upon local networks' with hospitals rated according to their performance against the trauma standards.

There would be about 27 level-one 'major acute' centres with a full range of specialties on one site, including neurosurgery and cardiothoracic surgery.

Level-two 'acute general' hospitals with fewer specialties could still receive major trauma but would work in partnership with level-one centres.

Patients with life-threatening injuries would bypass 'level-three' hospitals.

Junior health minister Gisela Stuart welcomed the report.

Better Care for the Severely Injured www.rcseng.ac.uk