The NHS debate is in appalling health Next Wednesday, the final report on the failings of the Mid-Staffordshire NHS Trust will be made public. It is expected to paint an utterly damning portrait of the modern health service, where mismanagement and neglect have resulted in the needless deaths of hundreds of patients. As Jeremy Hunt, the Health Secretary, knows all too well, change is urgently needed. Yet events this week show just how difficult this will be - not because of institutional inertia, but because of the startling immaturity of the national debate about the NHS. Yesterday, Mr Hunt announced the closure of South London Healthcare Trust. This has sustained hideous losses due to the crippling debts imposed by the Private Finance Initiative, lower patient volumes, a legacy of mismanagement and the fact that London has too many hospitals. Experts recommended that, as part of the rationalisation, certain services at Lewisham (which is not part of the South London trust) should be transferred to nearby Greenwich. This, understandably, infuriated people in Lewisham, who took to the streets in their thousands to protest at their hospital being made to pay for others" mistakes. In the end, acting on the advice of Professor Sir Bruce Keogh, the NHS's medical director, Mr Hunt decided to transfer some services, but move only the most specialist work from Lewisham A&E. This was done not to save money, but lives. The most delicate procedures are best concentrated in centres of genuine expertise: when they are not, the results can be fatal. Yes, journeys may be longer, but ambulances are now far better equipped to stabilise patients en route. The campaigners were having none of it. They insisted that Mr Hunt was a wicked villain; the unions chimed in that this was all somehow part of a sinister Tory plot to privatise the NHS. The same hysteria is seen when any service at any hospital is threatened: in 2001, the backlash in Kidderminster was strong enough to get a local doctor elected as an independent MP on an explicit anti-closure ticket. In a way, the Government has only itself to blame. In the run-up to the election, Andrew Lansley was eager to align the Tories with those communities fighting closures. David Cameron, meanwhile, spoke of the health service in terms of myopic veneration. Yet at some point, we must move beyond the emotional to the rational. The dead weight of PFI, the need for greater efficiency, and the simple moral imperative to save lives all point to a pressing need to rationalise and reorganise NHS services. Let us hope the Mid-Staffordshire report, in all its monstrous detail, can persuade the public of that basic truth.