A FORMAL letter will be sent to an NHS trust to express a council's lack of confidence in its health management.
The motion to send the letter was passed by all but one of the Hartlepool borough councillors at a full council meeting.
The authority unanimously backed a motion of no confidence in the board of North Tees and Hartlepool NHS Foundation Trust last September in protest at the closure of the town's accident and emergency department last August.
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However, no communication was ever formally made to the trust.
Only one councillor argued against it, and then only because he thought it would not change anything.
Councillor Stephen Akers-Belcher said: "We could write a letter in blood, in the chairman's own blood, and it wouldn't affect any outcome."
In the end, Councillor Geoff Lilley proposed a motion that the letter be sent, which was passed.
Patients with minor injuries in Hartlepool are being treated at the One Life Hartlepool Centre in the town and emergencies are being taken to The University Hospital of North Tees, in Stockton.
North Tees and Hartlepool NHS Foundation Trust has consistently defended the decision to close the A&E department following an independent review which recommended the move. The review said A&E services in Hartlepool were "not sustainable or safe for patients".