The question of how much influence local people should have on changes to NHS services is concentrating minds in the North West.

The issue resurfaced after HSJ published details of legal advice obtained by Blackpool Teaching Hospitals Foundation Trust in January before closing a 40 bed hospital at short notice.

The trust had asked what would happen if it shut the hospital without public consultation and was advised it could “run down” services ahead of consultation on “efficiency” grounds.

Although the trust says the closure is a “short term measure pending full public consultation”, the story provoked predictable responses: outrage from the public; frustration from HSJ readers.

“Everyone wants a hospital at the end of their street!” said one commenter. “The most effective use of scarce resources should be the key criterion for decisions.”

Justifying reconfiguration to every aggrieved MP, local journalist and the public has always been an issue for managers, but it will get worse still as the savings targets become ever more gruelling.

A further twist in this case is that the hospital in question is in fact not a crumbling 1970s anachronism but a private finance initiative building opened in 2001.

Another PFI site in the region facing reconfiguration is Edale House, home to 82 Manchester Mental Health and Social Care Trust beds. According to NHS North West, the trust never wanted the PFI, thinks the building is unsuitable, and would save £1.7m a year moving the unit elsewhere.

Who should decide the “most effective use of scant resources” in this case? Answers on the back of a consultation response, please.