Few managers - even those who have struggled long and hard to push through unpopular acute beds cuts - are willing to contemplate that their service reviews might have to be scrapped in the light of Mr Milburn's instruction to plan for increases.

Worcestershire health authority chief executive Pat Archer-Jones has faced down fierce local opposition to an HA-led local service review, which will turn Kidderminster District General Hospital into an ambulatory care centre. But she's not afraid of Mr Milburn's model. 'It seems to me the key in his statement is 'the right beds in the right places' We shouldn't just think that the secretary of state is talking about acute beds here. '

With any major service reconfiguration there is a constant process of checking and re-checking, which next month's model will add to: 'I think it could be helpful because it could hopefully provide benchmarks against which we can measure our own calculation. '

Birmingham has long been a service review hotspot over plans to replace Selly Oak and Queen Elizabeth hospitals, which were opposed by South Birmingham community health council. HA deputy director of public health Dr Stephen Munday insists that local bed numbers calculations have 'a certain amount of flexibility'. 'I don't think we will be put in a difficult position, 'he says.

The model might even, he adds, make it easier for HAs and trusts to present planned service changes without automatically provoking hostility from local populations.

Dr Jonathan Michael, chief executive of University Hospital Birmingham trust, adds that the trust board has indicated its commitment to taking into account the 'lessons'of the national beds inquiry: 'It welcomes any further guidance from the NHS. '