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Gross underfunding of the National Health Service in England and Wales results in too few beds and operating theatres and too few nurses and doctors. Thus, standards of surgical care, particularly for emergencies, are compromised. The service requires sufficient senior and trainee surgeons to meet the needs of specialization, working together in an acceptable surgical rota which enables both dedication to emergency admissions and continuity of care. Calculation of local manpower needs demands an understanding of the acceptable workloads for operating and outpatient activity and assessment of the NHS and private surgical work carried out in the area. For general surgery and trauma and orthopaedics this equates to 1 consultant for 30 000 population. Emergency surgical services require the presence on site of all the core specialties, including sufficient fully staffed intensive-care, high-dependency and coronary care beds to ensure their availability for emergency admissions together with 24-hour-staffed dedicated emergency operating theatres.