It is not simply about trying to save money

Keeping some big hospitals open probably doesn't make clinical or economic sense.

There will be new, smaller buildings and different ways of providing care. The public need evidence that these will be better services and this is not simply about nasty managers trying to save money - because it is not.

It is unavoidable that we will see some hospitals closing and it is always difficult for the public to accept that.

NHS London is correct that funding will be squeezed in the next five to six years.

The policies of creating polyclinics, centralising some services and moving others out of hospitals make clinical sense and it should have been done years ago all over the country.

There is a degree of uncertainty in the idea that polyclinics will bring more productivity and therefore help create £5billion of added value.

Given the state of the economy the NHS cannot simply do nothing. I give NHS London a lot of credit for finding an evidence-based solution. They are not pulling these ideas out of a hat.

* John Appleby is chief economist on health policy at King's Fund, an independent charity which works to improve healthcare.