Over the past 5 years, a succession of recommendations or guidelines on the acute management of patients with a head injury have been published. These documents reflect developments in imaging technology, the benefits of specialist neurosurgical care and the need for rehabilitation and follow-up. To a large extent, improvements to the shortcomings of current clinical management will be dependent on the provision of adequate resources, in particular at neuroscience centres. This paper states the present stance of The Royal College of Surgeons of England in respect of key issues addressed in the above publications and reviewed below.