Health secretary Patricia Hewitt has given her strongest promise yet that she will back managers wanting to drive through difficult hospital closures and service reconfiguration.
And in the week before the national clinical directors are due to publish reports on the need for service redesign, she said it was 'crucial' that clinicians were also signed up for change.
She told primary care trust managers at the NHS Alliance conference: 'I will work with you to get all the time the best care for patients even when it means taking difficult and unpopular decisions, and backing you in these difficult decisions.'
Ms Hewitt described her decision to back managers in West Yorkshire over the closure of a consultant-led maternity unit in Huddersfield and the maintenance of another in
'The clinicians were absolutely clear - they could not staff them both safely,' she told delegates. 'There were huge protests in Huddersfield because they did not want to lose their consultant-led unit?it was very noisy, very nasty, horrible.'
She called in the independent reconfiguration panel, which brought out 'a very thoughtful report which said of course people want everything in their local hospitals but you can't do that with modern medicine'.
'They said it was the right decision; I absolutely backed that. The decision is now done. It was the right decision and also the right process to take people with us.'
She added: 'The critical thing was the clinicians getting out there and making the argument and defending the decision. So I will absolutely back you [managers] and we will help in the [Department of Health].'
Ms Hewitt said changes were also afoot in other areas, such as emergency services and urgent care. 'Complex care like primary angioplasty needs to be done in specialist centres, with round-the-clock surgery available to patients who need it, because we will save more lives, even though it will mean some patients will have to travel further,' she said. 'Immediately the cry goes up - you're closing my A&E. That's why we need to get better at making the clinical argument.'
DoH commissioning director Duncan Selbie backed Ms Hewitt's comments. 'I can tell you that working in the DoH there has never been a time when people have been so for this, providing the case for change is good,' he said. 'And if it can be set out around the preventive path then you'll get all the support you need.'