Guidance

Learning from reviews of proposals for NHS service change

Published 20 February 2024

Applies to England

Since 2003, the Independent Reconfiguration Panel (IRP) has given advice to the Secretary of State for Health and Social Care about NHS proposals for service change that have been contested by local stakeholders. We first distilled learning from our work in 2008 and have revisited it regularly in light of fresh evidence and a changing health policy context.

Taking account of recent cases that have been referred to the IRP by ministers, and the impact of changes in legislation implemented via the Health and Care Act 2022,  our experience suggests that the following factors make it more likely that proposals for change will successfully deliver high quality and sustainable NHS services.

1. The local community is involved from the first stage of considering change

• the public and other stakeholders, including MPs, community groups and health and care staff, have been involved in the development and consideration of the proposal from the outset

• the process is transparent from beginning to end so that consultation or engagement is truly meaningful and responses are given proper consideration before the final decision-making business case

2. The relevant local authorities affected by the changes are actively engaged with throughout the process

• there is a good working relationship with the local health overview and scrutiny committee

• timescales given for the health overview and scrutiny committee to provide comments in response to a consultation are realistic and achievable

• although a single or joint scrutiny committee may be the statutory consultee, other local authorities within the catchment area who may be affected by the changes are engaged in the planning process and given the opportunity to share views

• where disagreements arise, the NHS and the health overview and scrutiny committee take all reasonable steps to try and reach agreement locally before making a request for the Secretary of State to intervene

3. The proposals set out a clear vision for joined-up and person-centred health and care with a credible clinical case for change

• the benefits for patients are clearly articulated and communicated and set out how the changes will improve the quality, safety and effectiveness of services and enable patients to make informed choices about their healthcare

• the proposals align with relevant policies and guidance from the Department of Health and Social Care and NHS England

• there is strong support  from the local Clinical Senate as well as clinicians working on the front line of services

• the clinical pathways and NHS processes are explained in plain English to the public and other stakeholders to help their understanding, bearing in mind that business cases for service change and capital investment are technical documents and may not be easily understood by those not working in the NHS

• the different scenarios that may cause people to seek treatment are clearly explained to the public so that they are aware of how to access the right care at the right time and in the right place once the reconfiguration has been implemented

4. The planned use of resources is sustainable to maximise the benefits for patients

• where there are financial assumptions that rely on significant revenue savings or reductions in clinical activity, these are supported by robust mitigation plans and assurance processes to ensure that the plans are financially sustainable and will credibly address the risk of any increased future demand for services

• for proposals with estates issues, such as those which involve the closure of a hospital building and often provoke a strong local reaction from the public who may view the site as a community asset, the NHS has clearly communicated with the public about how they will be involved in determining the building or site’s future should the proposals be implemented

5. The proposals address the need to reduce inequalities in health and healthcare

• the impact assessments cover inequalities in both health and healthcare, such as the impact on access to healthcare, the patient experience and health outcomes

• factors such as socio-economic deprivation, changes in demographics, and healthy life expectancy have been considered using a system-wide approach

• the impact of population growth on future demand for NHS services, for example due to new housing developments, has been considered

6. The proposals clearly address any trade-offs and how the risks will be mitigated, including the impact on travel and transport

• plans to centralise services, such as the separation of planned and emergency care, have clearly communicated the clinical evidence for receiving care in the right place first time and how this is balanced against the trade-off of longer journey times to hospital for emergency ambulances

• there are protocols in place for ambulance conveyances and transfers between hospital sites that have been agreed with the local ambulance service and the revenue funding consequences for ambulances have been considered

• for proposals where the relocation or centralisation of NHS services may result in longer or more challenging journeys for staff and patients, particularly via public transport, there is a standing group of stakeholders in place, including staff and patient representatives and local transport providers, to develop an action plan to mitigate any negative impact

If further guidance is required, the IRP Secretariat is available to offer informal advice on NHS reconfiguration issues upon request via our mailbox at IRPinfo@dhsc.gov.uk.