The city of Birmingham has seen rows before over hospital building plans. But there is a new ferocity triggered by the decision of a local community health council to object to the£200m project to replace the ageing Selly Oak and Queen Elizabeth hospitals.
John Charlton, chair of University Hospital Birmingham trust, can scarcely contain his anger as he accuses members of South Birmingham CHC of traducing their public health watchdog remit when their real concern is to oppose the private finance initiative.
And CHC chair Ursula Pearce charges local MP Steve McCabe with using parliamentary privilege to accuse the 14 members who voted to object of mendacity, by tabling a question in the Commons (see box).
And all of this is happening as Birmingham health authority nears the end of its consultation period on proposals for future acute hospital services in south Birmingham.
Mr Charlton says it is 'hard to deliver a scheme of this size' so it would probably have ended up on the desk of health secretary Frank Dobson in any case.
But he finds it difficult to forgive the intervention of the CHC because it will undoubtedly delay the process - and, as he puts it, previous objections have meant that the city has not had a new hospital for 61 years. 'Once again Birmingham is shown not to be united around proposals for a new hospital,' he says.
Mr Charlton says the CHC has 'not come out with any sense at all' in its lengthy 14-page response to the HA consultation. 'The truth of the matter is that they are opposed to the principle of the PFI', which, he says, is irrelevant when the consultation is on a change to service provision.
'So they have come up with an alternative scheme, which is absolute nonsense.'
He says the CHC scheme has been designed by David Spilsbury, one of its members, who canvasses on a wider political stage against PFI in general and its use for new hospitals in Birmingham in particular.
'The arguments in relation to clinical care are just nonsensical,' Mr Charlton says.
'It is just a cover to enable them to put in an objection.'
He also points out with some acerbity that Mr Spilsbury is a Birmingham city council nominee to the CHC and that the council supports the new hospital proposal.
The CHC is quick to respond that the council's support is very recent. In February 1997, three months before unexpectedly winning the previously safe Conservative seat of Hall Green, Mr McCabe, then a councillor, proposed a successful motion opposing PFI funding for a new hospital in south Birmingham. Now, as an MP, he backs the idea.
Mr Spilsbury knows that the hospital project has the backing of both Lord Hunt of Kings Heath (formerly chief executive of the NHS Confederation) and local MP Gisela Stuart, the two new members of the Department of Health ministerial team.
Which means, he says, that 'we do not feel our argument stands much of a chance' in opposing what he describes as 'a new-build under PFI with 10 per cent fewer beds'.
Not that the CHC is giving up. It proposes that, instead of the new hospital, there should be a plan to repair and gradually develop the two existing hospitals.
They list three major concerns in response to the consultation:
fear of a 'drastic reduction' in acute inpatient care based on 'unproved assumptions that fly in the face of current trends and research evidence of a growing need for acute hospital care';
concern that financial demands on the new hospital would reduce the trust's available income for treating patients by 'at least£26m a year';
worries that there would be job losses among medical and qualified nursing staff while non-clinical staff would be transferred to non-NHS employment.
Mr Charlton asserts that the bed losses would amount to no more than 30.
He adds that, far from causing job losses, the trust faces a continuing problem in recruiting enough doctors, nurses and professionals allied to medicine for the foreseeable future .
And he charges the CHC with being fully aware of the 'disgraceful' conditions at the existing hospitals, with appalling conditions for patients and staff alike at what is supposed to be one of the country's premier teaching hospitals.
Selly Oak Hospital, he points out, is 100 years old and a former Poor Law institution, while Queen Elizabeth Hospital was designed in the 1920s, before penicillin was in common use.
Ms Pearce says the CHC is 'being seriously misrepresented' as having ideological objections, when its main concern is the constraints imposed on the new hospital by Birmingham HA.
The CHC objects in particular to 'radical savings' on inpatient beds which will be reinvested in primary care.
Ms Pearce says the proposal is directed particularly against elderly people, although geriatricians have told the CHC that the group is not being inappropriately admitted to hospital.