Health experts want to see Southport and Ormskirk children's and adults' emergency services back on one site - and the battle lines are already being drawn over which hospital they will go to.
The "ideal solution" would be a new hospital to replace the existing two facilities, but that could only be achieved if significant NHS funding becomes available.
Southport and Ormskirk Hospital NHS Trust faced overwhelming criticism in 2003 when it shut Southport's children's A&E and maternity services and Ormskirk's adult A&E.
More than 26,000 people signed a petition against the move with thousands joining a protest march through Southport town centre.
Now Northern England Clinical Senate, in an investigation commissioned by the trust, says emergency services should be concentrated on one site.
Report author Prof Andrew Cant said: "The current configuration is inefficient, unsustainable and potentially dangerous."
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It raises the prospect of a battle between supporters of Southport Hospital and Ormskirk Hospital to see which will emerge as the "hot" or the "cold" site.
Prof Cant said: "Maintaining a clinically sustainable organisation across the current Southport and Ormskirk sites will be difficult for a population of 230,000 as it is hard to sustain viable services for one district hospital for such a size of population, let alone two.
"A new build hospital site with good road access to both Southport and Ormskirk would be the ideal solution for the trust.
"However, in the current financial climate access to funding required seems far from certain and the lead in time for this would still mean that an interim service reconfiguration with better working with neighbouring acute providers is still required."
That would mean downgrading either Ormskirk or Southport to a "cold" site with a risk that children's A&E and maternity services could be lost altogether, with patients having to travel elsewhere in the region.
Prof Cant said that combining the separate paediatric emergency department and maternity services currently at Ormskirk with the adult emergency department, emergency surgery and intensive care services currently at Southport was "a matter of priority".
He said: "Trying to staff two emergency departments (EDs) with the number of ED consultants available will be extremely difficult in the present and harder to sustain over the longer term.
"Maintaining a paediatric ED on a separate site to the adult ED is not sustainable and relocating all emergency care on to the single site would seem to be the most appropriate way forward.
"One site has the better building and estate capacity with a population requiring access to maternity and paediatric services (Ormskirk) whilst the other has greater demand for acute services driven by the aged population but in a building which is more cramped and in need of investment (Southport).
"However, given the current vulnerable state of the services, the declining current operational performance, and the serious financial position, there must be a serious risk of the trust entering a downward spiral from which it cannot recover; a decision does need to be made.
"Should the full range of services currently provided at Southport and Ormskirk Hospital NHS Trust be retained, then on balance we think Ormskirk as a "hot" site is the marginally better option.
"Were the full range of services provided out of a hot site at Southport, the demand for maternity services would almost certainly drop to unsustainable levels and the demand for paediatric services would also be severely undermined."