The row in Cornwall over plans to move a cancer service out of the county encapsulates the struggles primary care trust managers face when trying to improve services.

The local PCT - Cornwall and Isles of Scilly - wants to move the service to Plymouth, where the volume of cases will ensure patients receive the best available care. The move precisely reflects national commissioning guidelines on improving cancer survival rates.

The PCT has spelt out its case simply and carefully, even wheeling a respected surgeon from outside the region into a council meeting to help convince opponents.

But, as so often in reconfiguration debates, rational policy finds itself submerged in an evidence-free tidal wave of emotionally loaded rhetoric.

According to the local media the plans have been attacked as appalling, cruel and inhumane - a venomous charge sheet for moves intended to save lives.

In a surreal twist the PCT has been accused of focusing on the clinical case rather than the effect on patients. This ignores the fact that the plans are trying to address the issue of patients being avoidably dead, which is a pretty big effect in anyone's book.

As PCTs begin to pull harder on their commissioning levers these sorts of disputes will multiply and intensify. Hard evidence, thick skin and steely determination will be indispensible attributes of PCT leadership.

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