Strategic health authorities grappling with trusts that will fail to make foundation status face opposition whichever way they turn.

This week’s HSJ poll of MPs and council health scrutiny chairs reveals many reject all the likely options - merger, takeover, franchise or cuts. Even firing the trust board didn’t please the crowd.

This wall of rejectionism will be familiar to anyone who has been involved in a service reconfiguration. It is a stance managers will experience a great deal more as the imminent squeeze on public services funding compels tough choices.

While former health secretary Frank Dobson describing the available options for Great Ormond Street as lunatic may not come as a shock, it is indicative of the anger that can be stirred up when change is needed. Even Cabinet ministers have taken to the streets to oppose service closures.

There have been murmurings of pushing the deadline for foundation trust applications back beyond the end of next year, in the hope that some of the 20 stragglers could yet succeed. The 2010 deadline is already two years later than originally envisaged by Alan Milburn. Extending it yet further would undermine the credibility of the application process, while the worsening financial backdrop means the eventual outcome for these trusts would probably be a more drawn out death rather than resurrection.