Today’s announcement on congential heart disease services is the latest battle in a very long war. 

The trusts which today threaten to take action to protect their congenital heart disease services follow in the footsteps of others in 2013 and 2011.

The dispute between commissioners and the units that provide these services is an emotive one and points to a number of failures in the NHS since the Bristol Heart Inquiry in 2001.

The failings are of medical culture as much as NHS management, the latter of which has sought to square the circles created by irreconcilable clinical differences.

The evidence on volume of procedures leading to better outcomes is obvious and axiomatic, but a focus on this overlooks the more vexed local factors which trusts dispute.

If providers are successful in overturning yet another move to centralise services, the NHS will have to ask itself whether national leaders will ever in practice wield sufficient power to make it happen.

In some ways the arguments are the same as they were in 2011 when the Royal Brompton took its challenge to previous proposals to the High Court.

In other aspects the landscape is different. Foundation Trusts operated with a greater degree of freedom in 2011 than they do now; NHS England is the single national commissioner and has a strong, politically minded chief executive.

Interestingly it seems that it is now the non-FT, Leicester, which is giving the strongest hints that it will take legal action to seek to overturn NHS England’s plans.

The war seems likely to go on for some time yet, while the time passed since those avoidable deaths in Bristol grows longer and longer.

Three trusts set to lose specialist heart surgery