Tough decisions still need to make a case

Managers attempting to restructure services across Bedfordshire and Hertfordshire strategic health authority may feel they have at last got friends in the right places.

In January, the health secretary highlighted the area as one where action 'to deal with systemic problems' is required.

Last week, one of its acute trusts announced a spectacularly tough decision.

West Hertfordshire Hospital trust is about to consult on plans to 'withdraw' all the services it runs from one site next year - around six years before services are reconfigured across the counties. This would see the redevelopment of its Watford site and the addition of a new hospital in Hatfield. In the meantime, Watford will be bolstered by 'modular buildings'. The trust has been brutally honest about the reasons for its decision: as things stand, it is financially unsustainable.

So is it time to test the government's mettle? Perhaps not. From the prime minister down, the government has made clear it will support tough decisions - if they are sensible and properly taken.

Sensible? A six year gap between replacing much of the old with new is hardly the way to command the confidence of local people. And talks about 'working with primary and community services' on interim replacements are not enough to reassure.

Properly taken? The news emerged soon after a public board meeting at which the plans were not mentioned.

Government guidance on consultation is due shortly. But if managers are to take difficult decisions, they would do well to demonstrate a spirit of openness that goes beyond the letter of the law.