The reports launched this week, written by national emergency access director Professor Sir George Alberti and national heart disease and stroke director Professor Roger Boyle, argue that traditional accident and emergency departments are not the best places to treat many patients, writes Daniel Martin.

The reports launched this week, written by national emergency access director Professor Sir George Alberti and national heart disease and stroke director Professor Roger Boyle, argue that traditional accident and emergency departments are not the best places to treat many patients, writes Daniel Martin.

Sir George warned: 'We can't leave it up to politicians to lead on this, and you can't leave it up to managers because they are not believed. Clinicians have got to lead on this.'

At the same event, health minister Andy Burnham said he hoped the reports would help 'bolster' managers and clinicians pushing for reconfiguration in their areas. But he admitted there was a 'growing sense of political fear' in the face of anti-reconfiguration campaigns.

The clinical directors' reports said that for many cases of heart attack and stroke, the best care could be provided in new 'super A&E departments' likely to serve larger populations, and deal with major trauma.

Sir George said he was touring the country to offer advice to trusts contemplating reconfiguration, but he refused to put a figure on the number of departments that could close or how many 'super A&Es' there might be.

Chief medical officer Professor Sir Liam Donaldson said: 'Doctors need to take charge. Many of them privately talk about the need for change but they feel intimidated when faced by a placard-wielding public.'

He said providing more specialist services on one site 'might be more inconvenient for patients but is more likely to save their life. If the public knew that, I think they'd be more likely to put their placards down.'

Meanwhile, think-tank the Institute for Public Policy Research brought out a report claiming that campaigns to save district general hospitals could result in more than 1,000 unnecessary deaths each year.