Reconfiguring hospital services: a bold move to improve health care?

The need to reconfigure hospital services to improve the quality of care and patient safety is widely understood if not universally supported. Public opposition – often reinforced by local councillors and MPs – to changes in where services are provided often delays these changes, even when the clinical case for doing so is clear cut. How then can the process of reconfiguration be improved to expedite decisions that are becoming ever more urgent?

In a new briefing paper on reconfiguring hospital services, we put forward several suggestions, drawing on our analysis of experience to date. These include the suggestion that the NHS Commissioning Board should set minimum quality standards for key clinical conditions, with these standards being used by the Care Quality Commission (CQC) in registering providers. Hospitals that fail to meet the standards would not be able to provide services for that condition.

Equally important is the need to ensure effective public engagement in consultations on reconfigurations, with the new health and wellbeing boards having a pivotal role in making this happen. Strong clinical leadership is also essential in the areas affected by changes in the location of specialist services. The proposed clinical senates will need to have a clearly defined role, which uses their clinical expertise and broader geographical overview to inform the configuration of services. Monitor must take account of clinical and quality considerations in regulating the health care market and work closely with the CQC to ensure a consistent approach.

Previous work by the Fund analysing experience in south east London concluded that strong strategic commissioning is needed to deliver the service changes necessary to drive up quality of care. Primary care trusts were too small to force through improvements where action was needed across a number of hospital sites. It will be important to be clear where this responsibility lies when strategic health authorities are dissolved and clinical commissioning groups are established. How will they work with the NHS Commissioning Board in handling complex reconfigurations?

Even if these suggestions are taken up, they may not be sufficient to overcome the obstacles and delays in current arrangements. For this reason, we believe two more radical options should be considered. The first would be to make the Independent Reconfiguration Panel the final arbiter of decisions. The second would involve establishing an independent commission – as happened in Ontario – to lead work on reconfigurations at arm's length from government.

The common feature of both options is that they would de-politicise decision-making – equivalent in its own way to the establishment of the Monetary Policy Committee to set interest rates independently of government.