With the publication recently of the results of learned deliberations of two working parties of the Royal College of Physicians (RCP),1,2 attention continues to focus on the organisational and training aspects of the care of the seriously ill. These documents are the latest in a series of publications that have made proposals for improvement. The intensive care medicine (ICM) community has for many years been drawing attention to the plight of the critically ill, with frustratingly little response from the UK Department of Health. The Audit Commission report Critical to Success3 provided independent evidence that variation in facilities and patterns of operation had important impacts on patient care and cost-effectiveness. Published subsequently were a report of the National Expert Group Comprehensive Critical Care4 and an operational document from the Department of Health.