I think the main problem with the current NHS targets is they fail to involve any "clinical need" into them. As you say getting an FRU quickly to someone isnt the best thing if they need to be taken to the hospital. A lot of the prioritising of cases clinicians used to do from experience is now taken over by meeting targets. Regarding specialist centres I did read a news story that if you're involved in a trauma case you're much more likely to survive if you're taken to a hospital that regularly deals with trauma compared to one that maybe only deals with one major trauma a month.