Nigel Edwards made reference to Neath General Hospital. Obviously, each hospital will have to find an appropriate role which reflects the particular circumstances of its locality. However, in order to balance local access with quality and cost of services, our experience suggests the need to provide high-quality, local diagnostic provision that ensures that GPs are able to access local services, particularly in areas such as radiology. In order to make the best use of expensive equipment, not only does there need to be a comprehensive range of outpatient facilities, but a significant inpatient presence.

In Neath, as well as undertaking elective surgery with all the benefits that the article describes, we have continued to take undifferentiated medical admissions, including ambulance cases. These 6,000 medical admissions a year are significant, both in terms of maintaining local access and making best use of expensive diagnostic equipment. We have been able to demonstrate through the audit work undertaken that the absence of emergency surgical intake has not affected the quality of medical care provided.

Our own surgeons, who are employed predominantly to undertake elective work, have been able to provide necessary surgical support for emergencies. We are concerned that if a local general hospital only deals with outpatients and day surgery, a population of 150,000 cannot sustain the necessary investment in diagnostic facilities, and patients will increasingly be referred to more distant locations, where those services are available.

The Neath solution is intended as a long-term arrangement and, indeed, a new hospital incorporating the features of the Neath model is planned to open in 2001.

Andrew Bellamy Chief Executive Glan-y-Mor trust