A key milestone in the struggle to reshape the National Health Service is reached today as two NHS organisations square up in court over the future of children's heart surgery in London.
One in five NHS trusts is struggling to survive in the tough economic climate and the National Audit Office concluded last October that there were too many hospitals in the wrong places with the wrong specialties serving the wrong populations.
The first specialty to confront the challenge is children's heart surgery, which has spent a decade negotiating a plan, published last year, to concentrate services in fewer, larger centres to raise standards and improve safety, as well as save money. It followed a public inquiry into the worst hospital scandal of the 1990s in which scores of babies died or were maimed by sub-standard treatment in Bristol.
In London, served by three units, the plan was to close paediatric heart surgery at the Royal Brompton Hospital in Chelsea and concentrate the service at Great Ormond Street Hospital and Guy's and St Thomas's.
But it was blocked by the Royal Brompton which called the idea an "act of bureaucratic vandalism" and won a court order in November halting the move. The Safe and Sustainable NHS review, run by a joint committee representing primary care trusts, which drew up the plan, will today appeal against last November's ruling.