The Illawarra's northern suburbs have come out fighting against the latest threat to Bulli Hospital - a recommendation to close down its emergency department.The recommendation is contained in Commissioner Peter Garling's 1100-page report into the state's hospitals, widely lauded as the most significant health document produced in decades.However, Parliamentary Secretary for Health Andrew McDonald has said he would side with residents opposed to the closure when the Government sought input into the report. "It's an excellent report, but just because it's in (there) doesn't mean it's going to happen," Dr McDonald said. "I would not want any significant change to the function of Bulli ED (emergency department) and Camden ED."Bulli's a very good little ED and the locals know very well what it can and cannot do." Health Minister John Della Bosca's office has said Dr McDonald, the only practising doctor in Parliament, would have "a key part" in advising the Government on which of the report recommendations would be enacted, but clinicians, department health experts and the community also would have input.The Northern Illawarra Chamber of Commerce is among those already opposing the closure of Bulli's emergency department.It wrote to Mr Della Bosca yesterday seeking an assurance that services at Bulli Hospital would be upgraded.Chamber president Pauline Lacelles-Smith said northern suburbs residents would be forced to travel 35km to Wollongong Hospital or 65km to Shellharbour Hospital "when waiting rooms (there) are already at capacity", if services at Bulli were closed.Mr Garling's report left the door ajar for the closure of the entire facility. "Serious consideration then needs to be given as to whether, once these emergency departments are closed, it is viable to keep open a hospital and if so, what its purpose and role ought to be," the report read.Mr Garling recommended the Bulli closure after hearing submissions from Illawarra doctors concerned by the region's small hospitals.The doctors told the inquiry the smaller facilities resulted in frequent patient transfers that risked medical error and continuity of care, inefficiencies, rostering problems and wasted money. Last month, before Mr Garling's report was released, Member for Heathcote Paul McLeay told the Mercury closing the hospital's emergency department was "certainly not on the Government's agenda" and he would oppose any such move.The Government will respond to Mr Garling's report in March.