Nothing is calculated to generate fury more than the planned closure of an A&E department. It triggers a visceral reaction akin to a red rag waved at a bull.

So it takes a brave Health Secretary even to mention the possibility, a suicidal one to carry it out.

Nobody has forgotten Kidderminster, where after an outcry over downgrading the local hospital a sitting Labour MP was ousted by consultant Richard Taylor — who remains MP for Wyre Forest to this day.

It is, however, possible to make a case that emergency services would be no worse, and might even be better, if they were fewer in number.

The public wants quick accessibility, believing lives are saved by ambulances squealing their way through traffic to reach the A&E in seconds. If this was ever true, it no longer is. Ambulance crews are now well-trained paramedics able to stabilise patients and give emergency treatments. Except in rare cases, the time taken to reach hospital is not critical.

“Long ambulance journeys do not lead to more deaths,” said Sir George Alberti, the former national director for emergency access.

Specialist A&E units, fewer in number and therefore farther for most people to travel, would save more lives, the Government asserts.

According to the National Director for heart disease and strokes, Professor Roger Boyle, such centres would save the lives of 500 people suffering heart attacks, prevent 1,000 further heart attacks, and save 1,000 stroke victims.

Less serious cases, such as broken bones, could be dealt with in minor injuries units.

So there is a clinical case for “reconfiguration”, as the NHS calls it when it plans to close something. But it has cut little ice.

The doctors either disbelieve the claims, or use a more subtle argument to justify retaining an A&E. They say that loss of emergency services risks destabilising the hospital, and reducing its capacity to do other things.

An A&E requires the services of orthopaedic surgeons. Without an A&E, it is harder to sustain the necessary numbers, and the ability of the hospital to do elective orthopaedic operations is diminished. Costs rise, and it becomes uncompetitive. So closure of the A&E can have knock-on effects.

They ask why these clinical arguments for closures have emerged at a time when the NHS is short of money. The coincidence suggests that cash, and not best practice, is driving the changes.

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