Two government advisers have set out the case for so-called reconfiguration of hospitals, which could lead to some losing key services.
Prime Minister Tony Blair said they presented a "compelling" argument. So why do we need to close A&E departments?
A&E departments across the country are under review
Emergency care tsar Sir George Alberti likes telling a story about how he was once bitten by a farm dog while walking in the Lake District.
Instead of getting in his car to drive for 45 minutes to the nearest A&E department in Carlisle, he went to a minor injuries unit in Keswick.
He had the wound dressed, an anti-tetanus shot and was home before he would have even reached the A&E unit.
But Sir George says even if he had had a heart attack he would not want to go to the A&E department.
Instead, he would choose the James Cook Hospital in Middlesbrough, even if it could mean a trip by air ambulance, as he believes it would offer him a better chance of recovering.
"In a range of very serious emergencies from strokes to heart attacks, it may be better for patients to bypass the nearest local hospitals and be taken by highly-trained paramedics straight to specialist centres with the equipment, knowledge and experience - gained through treating many similar patients needed to save lives."
Or, to put it more bluntly, Sir George said he would rather spend more time uncomfortable in an ambulance than being "happy and dead".
But the challenge is convincing the public.
A wave of protests have been seen up-and-down the country as NHS bosses have begun consulting on plans to create super-regional centres of care at the expense of their local acute hospitals equipped with A&E departments.
Sir George, who has produced a report for the Department of Health setting out why reform is needed, said some people and even doctors are "deeply concerned" especially when the health service is racking up deficits.
But he added: "Finances may have been the issue that drew the media's attention, but they are not the reason for reform.
"Reforming emergency care is about responding to medical advances and providing new and better services in ways that allow the NHS to save more lives."
Sir George was joined by Professor Roger Boyle, the national director for coronary heart disease, in arguing supporting the proposed changes.
He told the BBC Today programme the current system of A&E departments at the local hospital was out-dated.
"The message is really quite a simple one.
"Medicine moves on. The new technologies need to be made accessible to everybody.
"They do require more specialised care, they require more specialised investigation.
"So if we are going to move to an angioplasty treatment for heart attack, or to a thrombolysis clot-busting strategy for stroke patients then we have to move the patients to the expertise rather more than we do at the moment.
"We need better strategies than the hold-all A&E department, or ER strategy that we see in the US, which is not an efficient way of delivering health care. We need other strategies that provide this."
And he added: "I think that if you ask any cardiologist would they prefer to have an angioplasty at a heart attack treatment centre, or stick with clot-busting treatment at a local level they would prefer to travel in an ambulance with a paramedic standing by in case of a problem."