Reconfiguration of NHS services (England)

Hospital and community health services in the NHS are often subject to changes in location or the type of treatment provided, usually as part of a reorganisation of services across a larger health geography.

NHS service reconfiguration can occur for a variety of reasons, for example to respond to financial or workforce pressures, provide more effective clinical outcomes, improve patient access to healthcare or react to new technological developments.

In England, reconfiguration decisions are largely made by local health commissioners or providers, with patients having a legal right to be involved, and local authorities having a right to scrutinise proposals. However, local decisions are often affected by national Government policy directions, or by pressures stemming from Government funding arrangements. The Secretary of State for Health also has limited powers to directly reconfigure services in the case of provider failure.

Reconfigurations can often be contentious with patients, particularly where they include proposals to close or downgrade a local hospital, and local politicians can often be held responsible for unpopular decisions made by health authorities or central Government. This is sometimes known as the ‘Kidderminster effect’, after Dr Richard Taylor, who defeated the sitting Wyre Forest MP David Lock in 2001 as an independent Health Concern candidate, following the downgrading of Kidderminster Hospital’s Accident & Emergency department.

Many current reconfiguration proposals in the English NHS are being delivered through Sustainability and Transformation Partnerships (STPs) – 44 area-based partnerships between local authorities and NHS bodies, delivering NHS England’s Five Year Forward View strategy.

This briefing paper looks at recent policy developments and trends regarding NHS service reconfiguration, the involvement of the public and local authorities in the reconfiguration process, and some of the major drivers of change.

As health is a devolved policy area, this briefing covers England only, except where otherwise stated. However, the briefing will be updated shortly with a brief overview of reconfiguration policy in Scotland, Wales and Northern Ireland.