AS a former colleague of Dr Booth, a highly respected consultant physician, I am pleased that he has at this late stage clarified his position regarding the acute services (Shuttle Letters, February 22).

I fully recognise the difficulties in maintaining acute services in the light of reducing junior doctors' hours.

This is a difficulty facing every hospital, although I accept it is moreso in a small hospital.

However, despite all the problems created by standards set by the Royal Colleges and by junior doctors' hours, while it may be unrealistic to insist on full return of all acute services including A&E, I remain convinced that there is a need to provide some form of acute service at Kidderminster with a catchment of over 100,000.

This view was reinforced recently when my brother was admitted with a heart attack to his local "cottage" hospital in Bridlington, serving a population of 25,000, into a five-bedded acute coronary care unit.

This was staffed by four consultant physicians, five staff grade posts and five senior house officers providing 24-hour cover, backed up by experienced, fully qualified nursing staff, and able to provide essential investigations such as echo cardiography and radiology.

With the nearest acute hospital (Scarborough) 16 miles away it was deemed too far to provide satisfactory response times by ambulances for emergencies.

This perhaps highlights the serious under-funding and consequent shortfall of consultant staff at Kidderminster, and is not necessarily a model for Kidderminster. But at least it demonstrates it still is possible to consider alternative ways of providing an emergency service, not hidebound by the constrictures of medical hierarchy.

When I have raised this possibility with colleagues it has been shrugged off as being unrealistic due to lack of appropriate staff.

If a small, out-of-the-way town such as Bridlington can attract staff then surely it would not be impossible for a far more favour-ably situated area from a medical point of view, such as Kiddermin-ster, to attract them?

At least such a unit would provide a staging post to deal with seriously ill patients, giving an opportunity to stabilise them before referring on if necessary to a specialised centre.

DR GH EELES

(retired pathologist)

Fairfield Lane, Wolverley