By Nick Triggle
Health reporter, BBC News
Money is expected to be tight in the coming years
Cuts to hospitals took centre stage in a health-themed election debate.
Maternity, children's and A&E units are currently being revamped in England.
But health secretary Andy Burnham accused the Tories of being insincere by promising to put a temporary ban on changes if they win power.
Shadow health secretary Andrew Lansley had argued that some of the plans were against patients' interests while the Lib Dems wanted local residents to be given more of a say.
The three health spokesmen were sharing a platform in an event jointly hosted by the British Medical Association, Royal College of Nursing, Kings Fund and NHS Confederation.
Reform of hospital services has been underway for a number of years to create centres of excellence which are supposed to be more efficient and provide better care at the same time.
It involves locating special lists of services in fewer places and is leading to some smaller hospitals losing high profile departments.
Mr Lansley said he was not against change but said proposals needed reviewing to ensure they were not "against the interests of patients".
But Mr Burnham said, "you are saying what people want to hear".
As Mr Lansley tried to explain his stance, Mr Burnham said "he had got himself into a large hole".
The health secretary said his party had made difficult decisions while in power including making changes in his own back yard - in reference to changes to children's and maternity care in Greater Manchester.
Lib Dem health spokesman Norman Lamb suggested local residents needed to be more involved in decisions.
"The decision should be taken by bodies that are democratically elected."
Clear differences also emerged in other areas.
Mr Lamb gave his backing to minimum pricing for alcohol, but both of the others were against such a move.
Meanwhile the Tories defended their policy of proposing a voluntary insurance system to provide care to elderly and disabled people.
Both Labour and the Lib Dems favour a compulsory levy.