Public engagement in relation to NHS service reconfiguration.

Public engagement in relation to NHS service reconfiguration. 
Mills & Reeves 3 February 2020

• Discussion of a judgement where the appellant sought to argue that two CCGs had breached the statutory duty to involve the public at section 14Z2 NHS Act 2006 (because the consultation needed to have taken place before the “retain services” option was discarded which had been done in committee) and that the consultation exercise undertaken by the CCGs was unlawful because it did not include consultation on a ‘do nothing’ option / did not explain why it had been rejected.

Multi site single service: improving outcomes, reconfiguring services - systematic review

Multi site single service: improving outcomes, reconfiguring services
PHE 4 November 2019

• ‘Multiple site single service’ (MSSS) models of care describe a method of delivering care across more than one clinical site or location, often across a regional geography, through a single clinical service or team. This systematic review examines the published evidence around MSSS models.
• It also sets out a universal framework to categorise different MSSS models which may be employed in the reorganisation of secondary care services, and a suggested set of outcome measures to guide planning, implementation and evaluation of future clinical service reconfigurations to better understand the population impact of service change.

Economics working paper examining diversion ratio in hospital mergers

Estimating diversion ratios in hospital mergers
Competition and Markets Authority 15 October 2018

• Understanding patient choice is vital in assessing the closeness of competition between hospitals. The standard technique used in the UK is to estimate substitution patterns based on historical GP referrals. 
• This paper compares the results of the ‘GP referral’ methodology to a demand estimation approach and highlights similarities and where this approach is problematic.

Planning, assuring and delivering Service Change for Patients

Planning, assuring and delivering Service Change for Patients
NHS England updated 22 March 2018

• A good practice guide for commissioners on the NHS England assurance process for major service changes and reconfiguration (including decommissioning).
• It sets out how new proposals for change are tested through independent review and assurance by NHS England, taking into account the framework of Procurement, Patient Choice and Competition Regulations. 
• CCGs are under a statutory duty to have regard to this guidance.

Reconfiguration of NHS services

Reconfiguration of NHS services (England)
House of Commons Briefing 9 October 2017

• An overview of 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.

Good practice principles for communicating service change in the NHS

Reconfigure it out: good practice principles for communicating service change in the NHS
NHS Confederation 17 October 2016

• This paper draws on the experience and insight of professional communicators who have been involved in reconfiguration programmes and considers the challenges and lessons learned to date from communicating service change programmes.  
• It also sets out good practice principles and advice for those leading current and future NHS reconfigurations.

How to make NHS mergers work better for patients

How to make NHS mergers work better for patients
NHS Improvement, 23 May 2016

• Working with Aldwych Partners and Cass Business School, NHS Improvement have used existing research and interviews with senior executives at NHS trusts and foundation trusts to produce resources for providers contemplating, planning or implementing a merger.
• Resources include:
• Mergers in the NHS: lessons learnt and recommendations (summary) 
• A summary of the merger process from beginning to end ‒ from creating a strategic rationale to achieving cultural integration. It sets out the biggest challenges that people leading merging trusts should anticipate and gives practical advice on how to overcome them.
• Improvements NHS providers have achieved through mergers
• Describes what service improvements and savings NHS trusts and foundation trusts have achieved in the past, offering insight into what others can realistically expect to achieve through merger.
• Factors affecting the success of NHS mergers
• Key factors that can affect the delivery of improvements through merger and practical advice on how best to achieve these for patients.
• Supporting evidence:
• Mergers in the NHS: lessons learnt and recommendations 
• Benefits from mergers: lessons from recent NHS transactions 
• Literature review:  Making mergers work: the experiences of healthcare providers in delivering merger objectives 

The drivers of reconfiguration and the evidence that underpins it

The reconfiguration of clinical services - What is the evidence?
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.

The reconfiguration of hospital services: is there evidence to guide us? 

In Future Hospital Journal June 2015

Read the underlying research report here:

Insights from the clinical assurance of service reconfiguration in the NHS: the drivers of reconfiguration and the evidence that underpins it – a mixed-methods study
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.