Radical changes needed to hospital services to ensure quality and safety of NHS care

The King's Fund has called for radical changes to improve the process for reorganising hospital services and to prevent politicians from blocking essential changes that improve the quality and safety of NHS care.

As MPs prepare to debate the government's health reforms once again, a new briefing paper published by the Fund highlights the urgent need to reorganise hospital services in some parts of the country to improve the quality and safety of care. The paper concludes that the current decision-making process for hospital reconfigurations is complex and bureaucratic, posing significant risks to the delivery of safe services.

The briefing paper argues that political opposition is often a major barrier to reconfiguration, with local MPs and councillors resistant to change, even when there is strong clinical and financial evidence of the need for it. It calls for a number of changes to improve the decision-making process and ensure that decisions about the organisation of hospital services are made on grounds of quality, safety and value for money. The briefing recommends that:

  • responsibility for driving forward changes to hospital services should be clarified during the remaining debates on the Health and Social Care Bill - minimum quality standards should be set based on clinical evidence – hospitals that fail to meet these standards should be prevented from providing services for a particular condition
  • maximum time limits should be set for different parts of the reconfiguration process so that decisions are made more quickly
  • the quality of public engagement in the process must be improved – responsibility for this should be given to new health and wellbeing boards
  • the roles and responsibilities of the various bodies involved in the process should be clarified and clinical involvement strengthened, with new clinical senates playing a significant role.

The paper also puts forward two more radical options for 'depoliticising' the reconfiguration process:

  • removing the Secretary of State from the process and allowing the Independent Reconfiguration Panel to make the final decision on contentious proposals (1)
  • establishing an independent commission with a mandate to drive through changes where they are needed – a solution that was used in Ontario, Canada in the 1990s.

Candace Imison, Deputy Director of Policy at The King's Fund, and the author of the briefing, said:

'Changes to the way hospital services are organised in some parts of the country are now a necessity, not an option, if the NHS is to deliver safe, high-quality care. With the NHS facing growing financial pressures and difficulties in recruiting staff with the right skills, politicians must grasp the nettle on this – not to do so risks allowing the continuation of poor-quality and potentially unsafe services.

Download the briefing paper: Reconfiguring hospital services

Notes to editors: 

The briefing paper Reconfiguration of hospital services is published on Tuesday 6 September 2011. For further information, or to request an interview, please contact the Press and Public Affairs team at The King's Fund on 020 7307 2585 (if calling out of hours, please ring 07584 146 035).

(1) The Independent Reconfiguration Panel is an advisory body that reviews and advises the Secretary of State on contested proposals for reorganising hospital services. It is required to assess whether proposals will provide 'safe, sustainable and accessible services for the local population', taking account of issues of quality, patient choice, GP referral preferences, the quality of public engagement and 'any other issues ministers direct'. The Secretary of State is not legally obliged to act on its advice and acts as the final arbiter on reconfiguration decisions.