A key part of any reform of our hospital services is clearly a reorganisation of emergency care. International evidence, cited by Hanly, is clear on this. Patients do better in hospitals that have the required numbers of specialist staff, are able to provide suitable medical cover 24 hours a day, seven days a week and have high volumes of activity and access to appropriate diagnostic and treatment facilities. At the heart of our reform programme, however, is the recognition that while we need to concentrate emergency care in our major hospitals, reorganisation of acute hospital services offers the potential for a wide range of safe, effective, high quality care to be offered in our smaller hospitals.