Medical leaders have signalled a major shift in their position on the centralisation of hospital services - casting fresh doubt on the drive to cut accident and emergency departments across Scotland.

Key figures in the country's royal medical colleges have revealed new research undermining one main arguments used for concentrating surgeons and physicians on fewer sites.

For years some health board managers and senior doctors have insisted patients are safer if they are sent to bigger hospitals because consultants need to treat higher numbers of patients to maintain their skills.

However, expert wisdom appears to be changing on this point.

Professor Neil Douglas, president of the Royal College of Physicians of Edinburgh and chairman of the Academy of Royal Colleges and Faculties in Scotland - which unites separate professional bodies, said: "There is fresh evidence which casts some doubt on there being a clear relationship between volume and outcome in terms of many clinical procedures."

The analysis of the data, which applies to Scottish hospitals, became available after a blueprint for the future of NHS Scotland was published by Professor David Kerr. Based on the new findings, Professor Douglas said: "It is an over-simplification to say the more you do the better you will get at it.

"There will be some specialist procedures which are very technical and better done by individuals who have got and maintain that significant experience.

"But that is a minority of medicine and probably surgery. For a large number of procedures, provided one keeps one's clinical skills up to date, then it is not simply a matter of the number of procedures you do determining your outcomes. It is a multi- factorial process."

He admitted this represents a shift in position that should be considered when overhauling hospital provision, but he cautioned there could be a number of other reasons for considering centralising hospital services.

These include the availability of support departments, such as intensive care which requires trained anaesthetists, and the availability of a range of staff to provide cover around the clock.

Nevertheless, Professor Douglas and Professor Brian Williams, president of the Royal College of Physicians and Surgeons of Glasgow, backed the independent scrutiny panel which published damning reports on the case for downgrading Monklands Hospital in Lanarkshire and Ayr Hospital in Ayrshire, this week.

The panel criticised the health boards concerned, NHS Lanarkshire and NHS Ayrshire and Arran, for using foreign research that was up to 20 years old and for omitting studies which raised issues about centralisation.

Professor Williams said he would be concerned if flawed evidence was used to downgrade the hospital departments.

Dr Andrew Walker, chairman of the scrutiny panel, said evidence on the number of cases consultants need to see to maintain skills should be analysed at a national level, rather than interpreted by individual health boards.

Published: 19 January 2008

Exclusive By HELEN PUTTICK, Health Correspondent

Reproduced with the permission of The Herald, Glasgow © 2007 Herald & Times Group