The Welsh Institute for Health and Social Care published an interesting document in April.1 Although aimed at the lay public, it actually deserves to be read by a wider audience—health professionals; it is a summary document describing known issues that govern thinking and planning for hospital services configuration. Its target audience will find it concise, comprehensible and comprehensive.

Selected comments relevant to the EMJ include:

• There is evidence to suggest that patients in Wales do not always get the best possible outcomes from hospital care … in some key specialties, notably major trauma, general trauma and emergency, stroke, maternity and neonatal care and paediatrics. The way Welsh services are organised falls well short of the optimal.

• There are acute pressures on medical staffing in paediatrics, emergency medicine, core surgical training and psychiatry, and more generally in some remote parts of Wales.

• In trauma and orthopaedics, Wales has difficulty maintaining safe standards when there are seasonal peaks in demand.

• There is now worrying evidence that patients admitted at the weekend, especially Sundays, are more likely to die than those admitted Monday to …