HISTORICALLY, out-of-date hospitals in Scotland have been replaced on or near site, with no consideration to future healthcare needs, resources or population spread, analagous to Generals planning for the last war. The debate over Monklands Hospital (“First step towards new hospital in Monklands”, The Herald, October 10) risks the same mistake. I would argue that the proposed £400 million and more cost of a new Monklands will be an unsustainable folly, and overburden Lanarkshire for the next century.

Greater Glasgow has reduced from five to two acute hospitals for a population of 890,000 yet thee acute hospitals are to be maintained for the Lanarkshire Health Board area with a population of 555,000.

Already NHS Lanarkshire has rationalised acute and elective care to Wishaw and Hairmyres, and can barely staff those hospitals. What would be the function of a new Monklands, other than to satisfy populist demand for "end-of-the-street”care? Recent service additions to Monklands could be seen as bargaining chips to keep the hospital open, but are minor resources easily moved.

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It is now clearly recognised that larger well-staffed hospitals with multiple specialities on site provide much better care than smaller local units. The clear example of the joint replacement unit at the Golden Jubilee, and heart attack care centres at Hairmyres are prime examples. Patients survive, do better and live longer. Is that not what we desire?

Arguments over accessibility in time and distance are secondary to quality of care, and the new Raith interchange and M8 extension trump that case.

If NHS Lanarkshire and the Government are brave enough, Monklands Hospitals should not be replaced but the money and staffing transferred would transform Wishaw and Hairmyres Hospitals into the exceptional units they can become.

Saving Monklands A&E was a shibboleth of the 2007 election, and arguably won the SNP power. Times have changed. Let populism and localism not cause the same mistake again. If, as Shona Robinson states, the decision must "consider the needs of the population right across the west of Scotland and deliver excellent care and value for money”, then spending what is likely to be half a billion pounds on an unnecessary hospital does not fit the bill.

Gavin R Tait,

37 Fairlie, East Kilbride.