Kings Fund November 2014
- New insights into the drivers of reconfiguration based on reviews of service reconfigurations conducted by the National Clinical Advisory Team (NCAT) and the underpinning evidence.
- Services include whole trust, community services (as a substitute for hospital care), mental health inpatient services, accident and emergency (A&E) and urgent care services, acute medical services, acute surgical services, elective surgical care, trauma services, stroke care, specialist vascular surgery, maternity services, neonatal services and paediatric services.
In Future Hospital Journal June 2015
Read the underlying research report here:
Health Serv Deliv Res 2015;3(9)
- This research set out to discover which services are being reconfigured and why, and what evidence is being used.
- The research used reports produced by the National Clinical Advisory Team (NCAT) (2007-2012) and research evidence.
- Drivers:
- The report concludes that the primary drivers of reconfiguration have been workforce (in particular the medical workforce) and finance. Improving outcomes and safety issues have been subsidiary drivers, though many make the link between staffing and clinical safety. Policy has also been a notable driver. with access notable by its absence.
- Despite significant pressures to reconfigure services, many proposals fail to be implemented owing to public and/or clinical opposition.
- There was strong evidence that some specialist service reconfiguration can significantly improve clinical outcomes. However, there are notable evidence gaps. The most significant is the absence of evidence that service reconfiguration can deliver significant savings. There is also an absence of evidence about safe staffing models and the interplay between staff numbers, skill mix and outcomes.
