By Branwen Jefferys BBC News health correspondent

A&E services in hospitals across England are under review

It is one of four hospitals in its trust which stretches out from north Manchester.

Under the new plans Bury, Oldham and North Manchester would keep full casualty departments. But Rochdale would be downgraded.

It could become the first locality hospital in the country, offering urgent but not critical emergency care, staffed by doctors and nurses. A final decision will be made in December.

The unit, a so-called locality hospital, would also see all the patients who now go to a nearby walk-in centre. But critical cases - such as patients injured in traffic accidents - would have to travel further to one of the other hospitals.

Fears

Lisa-Louise and David Fitton are among the minority that would have to travel

Their disabled sons have suffered from life-threatening fits. Their youngest son Dion died recently.

We've got to try to protect Jordan's life David Fitton, whose son needs regular hospital care

They want to go on taking his brother Jordan Lee to go to their local hospital in Rochdale rather than face the journey to Bury or Oldham. So they're seeking legal aid for a judicial review of the changes.

In their front room, surrounded by sympathy cards for Dion, David Fitton said they feared a longer journey could put a strain on Jordan Lee's heart.

"We can reach Rochdale in five minutes. By the time we reach Oldham it would be 35 minutes.

"We've got to try to protect Jordan's life. We'll do whatever it takes."

But emergency care is facing a shake-up nationally, and many specialists now accept that it has become almost inevitable.

The British Association for Emergency Medicine has said that, if services have to be centralised, it's important the changes are thought through carefully.

Many doctors accept that unless an accident and emergency department is backed by a full range of hospital services the very best care can't be offered to the most seriously ill.

With many district general hospitals under review, it now seems clear some accident and emergency services will be downgraded in the next few years as urgent care becomes concentrated in bigger hospitals.

Extra journey 'preferable'

At Rochdale the director of emergency care, Don Mackechnie, supports the changes.

He says concentrating accident and emergency on three of the four sites will allow them to improve care.

If most people had the choice they'd have a hospital at the end of the road Don Mackechnie, Rochdale A&E consultant

One reason is they will be able to provide more hours of cover from senior specialists.

As a doctor he is aware that patients are worried about the prospect of travelling further in a real emergency.

"I can understand that 100%. If most people had the choice they'd have a hospital at the end of the road.

"Unfortunately we can't deliver that in the modern NHS to the standards we need.

"The journey times are not going to be excessive. For my own family I think I'd rather have that extra journey with better care at the end of it."

Focus of attention

But reorganising accident and emergency is always politically sensitive.

While some doctors have been persuaded that it can be made to work, most local communities want the full range of services in their local hospital. Rochdale is no exception. More than 40,000 people have signed a petition against the changes.

Jean Ashworth, a Liberal Democrat councillor at the heart the campaign who insists they will keep on fighting any change right up to the decision in December. "We're not against change, but we are against putting peoples lives at risk and that's what they're going to do.

"They have to listen, this is a national issue, the downgrading of accident and emergency".

The North West of England is one of the first regions to consult on such potentially major changes.