Stafford may well be breathing a collective sigh of relief. Its hospital will not close. Even the A&E department will stay, although it will not reopen at night. After all the misery – described as "torrid" times by one of the administrators called in to work out whether the now notorious and debt-ridden Mid Staffordshire NHS trust had any sort of future – both Stafford and Cannock Chase hospitals are reprieved, although the trust itself will be dissolved. It has such a bad name now that maybe that was inevitable.

Meanwhile, on the same day, Lewisham hospital is also reprieved. The plans of another trust special administrator (TSA) – in this case appointed by health secretary Jeremy Hunt to sort out a financial mess in south London – have been torn up by a judge at the high court. It ruled that the TSA, Matthew Kershaw and Hunt were acting beyond their authority in planning to downgrade it.

It was a particularly hectic day for the NHS, but shocks, surprises, overturns, U-turns and lawsuits are all part of what we have come to expect from attempts at reconfiguration. Look at the saga around children's heart surgery, which has been brought to a halt yet again, more than a decade after it was recognised by everybody within the NHS that children are safer if fewer, more specialised hospitals offer these very complex operations.

For Stafford, it may have been the right decision. The hospital stays, but is downgraded. The routine care its increasingly elderly population needs will be boosted, with special services for the frail. The complex stuff, such as emergency operations and trauma care, as well as obstetrics and wards for very sick children who cannot be treated at home, will go to more specialised hospitals in Stoke and Wolverhampton. Stafford and Cannock Chase hospitals become the first port of call for local needs and will refer patients elsewhere if necessary.

That is the sort of model the NHS needs. Very specialised care cannot be provided everywhere. But there is a massive need for routine treatment, especially for older people. In south London this was known too. Unfortunately, Lewisham was earmarked to lose its A&E and other services because of another trust's financial disasters. Sorting out the right services for south London involved what hospital staff and local people considered an outrageous injustice against an indisputably good hospital.

Reorganisation of NHS care is essential and becoming more urgent as the population ages and the costs of caring for all of us rise. Where it has been allowed, it has been incredibly successful. Stroke patients are rushed past their local hospital these days to one further away with a specialist stroke unit. The same happens with trauma patients. Lives are saved as a result.

But the reorganisation of stroke and trauma care happened below the radar. A&E is highly visible. NHS medical director Sir Bruce Keogh will soon put forward plans to rationalise it, which will have to mean closing some hospital departments and replacing them with low-key urgent care centres.

Politicians inevitably join their constituents at the barricades to defend local services, as they did at Lewisham and in north-west London, where there are also closure plans. Consensus seems impossible. Bloodshed is far more likely.