THE management of the National Health Service, with the ever increasing demands of a growing population, is arguably the biggest challenge facing our country.

Anyone who thinks there are easy answers is deluded. The NHS is a hugely complicated beast. It has its faults. It makes mistakes. It requires change. But it also something to be treasured.

As changes take place, local controversies are inevitable, and the divided opinion over the investment of £20m in expanded accident and emergency facilities in Durham City is a case in point.

While the news has been welcomed by the people of Durham City, the adverse reaction in Bishop Auckland is entirely understandable given that the town lost its own A&E unit five years ago amid warnings that neighbouring hospitals in Darlington and Durham would be unable to cope.

There are times when the centralisation of health services makes sense because it enables expertise to be focused, especially in fields where specialists are in short supply. The recent centralisation of stroke care in County Durham is one example where patient care has been improved and the initial controversy has faded.

But feelings are clearly still running high over A&E changes. The passion people have for their local hospital in Bishop Auckland is underlined on our letters page today, just as the people of Northallerton made their voices heard when paediatric services were threatened at the Friarage Hospital.

Hospitals are extremely important to local communities. Local people have a connection to them and instinctively feel protective towards them.

As the NHS evolves – as it must – a balance has to be found between centralising expertise and retaining local accessibility.