The Academy of Royal Medical Colleges today suggests that cuts could be good for patient care. In a well-timed intervention, this consortium of the Great And Good swing their considerable weight behind rationalisation of NHS services.

Their letter points to the need for change to be supported by good clinical evidence, noting that "As techniques and technology have developed over recent years, speciality rather than proximity has become the key for patient safety".

The letter also swings in behind the 'care closer to home' policy driver, noting "strong evidence to support a large amount of more routine care, currently taking place in hospitals, being carried out closer to where patients live in the community with GPs playing a crucial role in the delivery of services".

It also gives a nod to civil service-speak, in observing the need for "strong leadership and brave decision-making from doctors, managers and politicians". And its line "Simply condemning change as bad and defending the status quo as ideal is not serving the interests of patients" will not be well-received in BMA House.

The letter rightly concludes that if the process of closures and changes "is to be managed well and properly provide the highest quality care in the best clinical environment, it must directly involve doctors, other healthcare staff and the public. This involvement should include a voice in the planning and strategy development for such services, thereby ensuring appropriate service reconfiguration driven by clinical evidence and not simply the need for financial savings".

Bravo for the organisers ARMC, and for all the signatories.

And you never know - this bravery-honesty thing is very new in NHS politics, but it just might catch on.