Last week's NHS Confederation conference was dominated by the issue of reconfiguration, with NHS chief executive Sir David Nichsolson, Health Secretary Andrew Lansley and NHS Confederation chief executive Mike Farrar peppering their keynote speeches with references to the pressing need for radical change.
Sir David and Mr Farrar said MPs must do more to support GP commissioners in making difficult decisions on whether to close hospitals or other services, after Mr Lansley said it was clinicians' who should be taking the bull by the horns in driving change.
One session that added something different to the discourse saw hospital bosses having their say on whether service design can help deliver financial sustainability.
As you would imagine, there were warnings about the destabilising impact of downsizing hospitals, but here was also an acknowledgement that difficult decisions do need to be made for the long-term health of the NHS.
Chris Bown, chief executive of Poole Hospital NHS Foundation Trust, which is merging with The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, put it succinctly: 'We have two hospitals, eight miles apart, and we do duplicate a lot. It's an honest conversation we need to have with our staff. But politicians also need to be honest with the public.'
Over to you, Mr Lansley.
Gareth Iacobucci is Pulse's chief reporter