Guidance

Insight on effective NHS service change from the Independent Reconfiguration Panel

Published 27 February 2020

This guidance was withdrawn on

Document withdrawn due to changes in ministerial intervention powers from 31 January 2024

Applies to England

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1. What is the Independent Reconfiguration Panel (IRP)?

  • a non-departmental public body set up in 2003 to advise on contested service change
  • members are public appointments
  • our current chair is Sir Norman Williams
  • 15 members (five clinical, five lay, five managerial)
  • supported by two staff

2. What the IRP does

Our formal role is to advise the Secretary of State for Health and Social Care on contested proposals for health service changes in England.

Our informal role is to respond to requests for information and promotes the sharing of knowledge and experience in the field of service change.

3. Formal role

Local authorities may use scrutiny powers to refer NHS decisions to the Secretary of State if they are not satisfied that they have been consulted adequately or if they consider the proposal is not in the interests of the health services in the area.

The Secretary of State may choose to commission advice from the IRP which is normally provided in 20 working days.

Occasionally further evidence may be needed in which case a further commission and timescale is agreed.

4. Learning from referrals

The IRP has advised the Secretary of State over 80 times. We first distilled our learning in 2008 and have revisited this regularly. Although the context has changed, many themes have persisted and in our experience, seven critical success factors make successful service change more likely.

5. Critical success factors

  1. Open community and stakeholder involvement from the first stage of considering change.

  2. A clear vision for the health and care of the community that provides the context for service change proposals.

  3. Money, transport and emergency care are expressed explicitly.

  4. A credible case for change that clinicians and patients advocate.

  5. The benefits for patients of change are articulated and communicated.

  6. Plans for implementation are sufficiently comprehensive to be credible to stakeholders.

  7. The process is transparent from beginning to end so that consultation is truly meaningful and responses are given proper consideration before final decisions.

6. Observations

  • the NHS has got better at this and can do better still
  • the NHS’s legal duties to involve are continuous - not just for service change
  • what do the public, patients and staff say?
  • what are their issues and assumptions?
  • how are they shaping what is happening?
  • be open and authentic to avoid surprises
  • embrace scrutiny as part of the process
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