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Reconfiguring hospital services

Lessons from South East London


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    Keith Palmer

The NHS is entering a period of acute financial pressure and needs to find up to £20 billion in productivity improvements over the next few years.

There are particular challenges for the many hospital trusts that enter the 'cold' financial climate with deficits and legacy debt.

Reconfiguring hospital services: Lessons from South East London considers whether reconfiguration of hospital services is an appropriate response to the need to drive up quality and drive down costs. Based on detailed analysis of proposed reconfiguration in South East London, it draws out important lessons to inform the debate about the merits of reconfiguration of hospital services elsewhere in England.

The conclusions may make uncomfortable reading for policymakers.

  • Market forces alone are unlikely to result in improvements in quality of care for patients in many hospitals, and could result in deterioration in some cases.

  • The transfer of commissioning from primary care trusts and strategic health authorities to GP consortia increases the risks of deterioration in quality of care for some patients and a widening of the quality gap between best and worst performers.

  • Reconfiguration that improves quality of care and reduces costs may require consolidation of services across hospital sites. Decisions about reconfiguration will need to weigh the resulting improvements in health care outcomes against the potential costs of reduced competition and choice.

Reconfiguring Hospital Services offers a timely and sobering contribution to the emerging debate on how service and organisational change should be taken forward across the NHS in England.