DC visiting hospitals? Hope he and his minders dont cross infect each hospital they visit!!

Paper pushers know best then?Economics versus the Hippocratic Oath. The golden hour will effect some of us who are now reading this, unless we die in our sleep somewhere cosy. This is the fright of our lives!!

maggie snook, wool wareham, Dorset UK

Any Government will fiddle & spin to save money. The need to resist these measures should be paramount. I just wonder what those agreeing with these cut backs would feel if it were one of their loved ones having to travel the proposed potential death extra miles. Ask the paramedics not politicians for guidance, they save lives each and every day. The money Brown wastes on bureaucracy, and inept systems would pay several times over to keep these lives saving service. I’d like to debate this issue with any politician who wasted our money on the dome!

michael, Sheffield,

So the number crunchers are meddling again and causing huge anxiety in the communities who are in danger of losing their A&E depts.

Now we have the prospect of David Cameron trailing around hospitals with his group of advisors, well meaning of course, but probably cross infecting and causing even more problems.
Health care cannot surely be all about saving money,isnt it about saving lives as the Hippocratic Oath implies.
Does any one remember the Oath? Is it taught any more?

maggie snook, wool wareham, Dorset UK

A mathematician might suggest that if the distance to A&E was zero the no one would die on the way to hospital and if the distance was infinite then everyone would die on the way to hospital. If we restrict ourselves to consider only those people with conditions that cannot be corrected in an ambulance i.e. most of them then the research the government cites is obviously 'flawed', that is to say rubbish.

Roger, London, UK

As with the need for the police to have focussed resources to combat organised crime and terrorism, there are certain medical conditions that are best dealt with through specialist units which, to be affordable, probably be sited in major zones of population.

However, neither of those particular situations can be used as an excuse to claim that all resources, for policing or health care, most, therefore, be centralised. The vast majority of both public services (if any of our politicians or bureaucrats still manage to combine those two words and understand their collective meaning) are used and needed locally for more general and day-to-day occurrences.

So do set up regional crime centres and specialist health units, but not at the expense of local operations for which we taxpayers need local access.

Malcolm MacINTYRE-READ, Much Wenlock, SHROPSHIRE

Why make so much publicity over a report that was produced from information gathered in 1997 to 2001,its well out of date. The UK has to move on and introduce up to date ways in healthcare.The new A&E proposals are following what France has been implimenting for the last five years and they have the best health system in Europe. Unfortunately this report has been made an issue by Camerons Tories and the UK right wing press for short term political gain and that wont save lives in the long term.

Bill Rees, Pieusse, France

I have seen this lunacy in action, recently I passed an RTA outside Ormskirk Hospital in Lancashire, paramedics were attending an injured driver, a few minutes later the ambulance passed me on its way to Southport, some 12-15 miles away. Ormsirk A&E having been closed. I doubt the drivers condition was improved by this needless journey, if it wasn't such a serious situation if could have been a sketch from Monty Python.

Dave Jones, Skelmersdale, UK

And the other corollary is that as critically ill patients die in transit the survival figures for the regional centres of excellence will be vastly improved and become a self fulfilling prophecy.
In the Falklands War, the absence of helicopter evacuation resulted in exemplary survival rates at the military hospital situated at Goose Green. however some thirty per cent died of wounds - a figure in excess of any comparable conflict.
Parochial reasoning requires that at least a stabilising level of care is required before triage and lengthy transfers of critical patients to centres of excellence within the "Golden Hour".
For too long the 8 minute target time for ambulance category A response has obfuscated the consequece of lengthy and inappropriate transfer of critical patients to Flagship hospitals at a distance, often past erstwhile excellent facilities.

John Tinsley, Newark, England

So a few people die.....less people for Brown to have to keep on state benefits. We should have the message by now.......we are not important.

Judy , Liverpool, england

The conditions which may benefit from treatment in a specialist centre currently account for less than 2% of our workload. Close the units down and who is going to look after the other 98% of patients?.

Travelling by ambulance is the riskiest part of the "patient journey", extend it at your peril.

Duncan, Norfolk,

The care and treatment received in the back of an ambulance is not improving as stated by the Governments advisor, it is a lottery as to whether you get a paramedic, rarely, or a technician or even the new grade of emergency care assistant. Most paramedics are now car based, being used to meet the governments target on response times.

Ken, Gloucester,

We are residents in West Wittering under threat of having our local hospital St Richard's, Chichester, downgraded. I have read the report with great interest, as this is the prime issue for us. To have to travel to Porstmouth or Worthing from West Wittering would add 30-40 minutes ( and that's on a good day) to an already quite long journey, especially with the crowded roads in the summer months, would certainly put our lives at more risk. I hope our PCT will seriously consider this report.

Dawn Wood, Chichester, West Sussex

If I had been in an accident and had suffered a ruptured spleen I would rather be taken to the nearby casualty department and operated on by a general surgeon, than spend longer in an ambulance bleeding, being transported to a super unit, and being dead on arrival. During the Vietnam war there was a concept of the 'golden hour', (the time to get patients properly assessed and resuscitated). Taking longer than this hour increased mortality. It is as true now as then, the quicker the journey time, the better the results. If this is not the case, why use expensive helicopters to transfer patients rapidly?

john Barber, Oxford, UK

You do not think you need a report to tell you this, common sence should of which this labour government has non.

Johnny Norfolk, Mileham, Norfolk

The corollary is that critically ill patients are more likely to receive comprehensive and 21st century medical care and hence achieve superior outcomes once they reach regional centres offering a full range of services.

The temptation to satisfy parochial reasonsings and appease historical inertia should be resisted.

B, London,