On the website of south London’s Sutton Guardian the story with the most reader comments concerns the closure of the accident and emergency and maternity units at St Helier Hospital.

So does the story with the second greatest amount of feedback, and the third, and the fourth.

The local MP has attacked the decision as “flawed” and is promising to “mount a successful challenge”. Some have suggested that it is inconvenient for the government that the MP is health minister Paul Burstow. The coalition would no doubt counter that it is an example of how it is no longer possible for ministers to pull strings behind the scenes.

HSJ reports that the financial support given to trusts has reached record levels. Some of the money is easing them over the final hurdle to foundation status, but a significant proportion is being employed to support failed organisations while alternative solutions are devised. Over the next two years, we are likely to see trusts slide from the former category into the latter as they fail to live up to Monitor’s demanding expectations. This will increase the pressure for reconfiguration, pressure which in some cases has been building for a decade or more.

So what will be different this time? Will we see a cash-driven rationalisation, a realistic right-sizing of the acute sector with patient safety to the fore, or will caution reign?

David Finch, joint medical director of the south west London review, points out that some of the same objections to the St Helier decision were raised to the reorganisation of the capital’s stroke services. As HSJ’s cover feature reports, that reorganisation has been a triumph with outcomes transformed in five years. Dr Finch says: “I’m convinced our proposal will save lives.”

How long will it be before MPs and other campaigners label the clinical commissioning group leads signing off the reconfigurations as “faceless bureaucrats”? And once battle is joined, who will the public trust, and who will they blame?

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