Reviews are taking place across the country

What is happening?

Local NHS managers are starting a series of reviews up-and-down the country into how hospital care should be designed.

In particular, they are looking at how acute services - that is to say emergency surgery, A&E, cardiac care and critical care facilities which treat the most severely ill - are provided.

There are 175 acute trusts in the health service, running about 250 hospitals, each providing some or all of these services.

This traditional district general hospital (DGH) model has been favoured since the very start of the NHS in 1948.

But some say it is now outdated as there is not the money or staff to cover an ever increasing amount of specialist care.

The reviews are looking at whether emergency care can be centralised into fewer "super" hospitals.

Is this being driven by money?

Yes and no. Many of the areas involved are facing financial pressures.

But the hospitals argue they are also motivated by the need to provide care more appropriate to the 21st century.

The government set out a strategy earlier this year to treat more people in the community.

Long-term conditions, such as heart disease and diabetes, have overtaken infectious diseases as one of the biggest burdens on the heath service.

Ministers - and many doctors - argue these conditions could be better managed in community settings by encouraging GPs to set up specialist services or hospital consultants to run clinics in the community.

There is also the issue of the European working time directive which is gradually being phased into the health service.

It means doctors can no longer work the hours they used to - either pacing the wards or on call - and so it is just not possible in a day-and-age when money is tight to employ all the new medics needed to staff specialist services in each hospital.

Some trusts run more than one hospital which replicate the same services, and they argue it makes sense clinically and economically to end this practice.

Does it mean that hospitals will close?

Perhaps. The British Medical Association fears that once key emergency services are taken away, the remaining departments - dealing with planned emergency, minor injuries and intermediate care - will become vulnerable to total closure.

In many respects, this makes sense. Keeping buildings open is an expensive business and as many of the remaining services can be provided elsewhere - by treatment centres, GPs and even in the patients' home - there would seem to be little reason to keep providing them from a hospital building.

But in the short-term, at the very least, the reviews currently under way, will lead to a cut in acute hospitals.

Once emergency care is stipped away, the hospitals lose their acute status and become little more than cottage hospitals.

What do patients think?

Ever since the NHS was set up after WWII, hospitals have been the service people most closely associate with it.

Whenever, closures or cuts are mentioned, people take to the streets demanding their local hospital remains open.

It has been no different this time. Significant campaigns have been - or are being - mobilised in each area where the idea of cuts have been floated.

Indeed, this remains the trickiest dilemma for NHS bosses. Many will not even speak about cutting hospital services, preferring to use words such as reconfiguration or rationalisation.