As predicted by the Daily Telegraph among others, Secretary Of State For Health Andrew Lansley (saviour, liberator) has backed the recommendation of the Independent Reconfiguration Panel that the A&E and maternity services of Chase Farm should relocate to the North Middlesex Hospital and to Barnet.

The vision is now to 'divorce' Chase Farm from Barnet hospital, and investigate the possibility of a management union (i.e. merger) with the North Middlesex.

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Chase Farm hospital will no longer provide maternity and A&E services. It will get a new Urgent Care Centre, by way of compensation.

This has been a long time coming, and is widely viewed among clinicians as the right decisions. And the voters of the immediate area to Chase Farm will probably hate it.

Here comes a phrase which doesn't get much use around these parts: well done, Mr Lansley. Our Saviour And Liberator is now going to take the lumps that are inevitable when your leader (That Nice Mr Cameron) promised to oppose a hospital closure in opposition.

As the Telegraph's Martin Beckford shrewdly notes, "When Mr Cameron, then Opposition leader, visited Chase Farm in October 2007 he declared, 'What I would say to Gordon Brown is if you call an election on November 1 we'll stop the closure of services at this hospital on November 2. What we've heard today from the Government is more plans for cuts and closures in our NHS. They cannot be trusted with our health service'.”

Marginal costs and benefits
Chase Farm is a Tory-Labour marginal, held by health Bill committee member Nick De Bois. It can be confidently predicted that he will not be happy (indeed, he has just issued a statement to that effect, calling OSAL's decision "wrong").

Enfield Council will be very annoyed indeed, having pushed an alternative plan that the IRP and Mr Lansley deem not to be viable. (Viva localism.) UPDATE - my thanks to a colleague, who rightly emails to note that "Barnet Council won't be pleased either - detaching CFH renders Barnet less viable, although it should be saved because it has the famous PFI force-field".

The DH press release indicates that part of the thinking behind this service change is also financial, citing the IRP's words: “serious concerns have been raised about the implications of not completing the implementation of the strategy for services at the North Middlesex Hospital following its refurbishment under a PFI scheme ... In 2007, the North Middlesex Hospital received £144 million to refurbish its facilities on the basis that those facilities would see a greater proportion of patients from the Enfield area – but those patients have continued to be seen at Chase Farm Hospital".

Money talks, loudly and clearly. Especially where PFI viability is concerned.

A challenge for Labour
Labour face numerous challenges in developing their health policy offering. One of the big ones is going to be how they deal with reconfiguration decisions that involve service closures.

The easy politics for Labour would be to oppose every change and closure.

It's almost certainly the wrong move.

London has been known to be over-hospitalled for a very long time, and governments of different political complexions have found ways of ignoring the problem. In an NHS facing the Nicholson Challenge of £4 billion efficiency gains a year for each of the next four financial years, this is no longer really an option.

If Labour were playing smart, they would offer a cross-party commission on reconfigurations. The scale of The Nicholson Challenge means that the pain will hit marginals and safe seats from north to south and from left to centre.

It looks worryingly as if the EU is heading towards a disorderly resolution to its own north-south fiscal and economic divide. This is likely to mean that there will be more for the main Westminster parties to argue about over economic policy in the coming months and years that is likely to be comfortable.

There will be sufficient points of differentiation to be had between Labour and the Coalition Government without making 'save every NHS facility everywhere' a desirable battle cry.

If we accept that services should be delivered as locally as possible in primary care, and on the clinically and economically appropriate scale in secondary care, then some political courage and cojones are going to be needed.

Lansley has shown some, in this instance. Will Labour?