I wonder why there is no mention whatsoever of patients and the public in this piece. I'm not so much bothered by the fact that they are ignored completely, as if they didn't matter, but by the lack of appreciation that informed public involvment could have an vital role to play in reducing demand. Choice of provider is not nearly as important as choosing whether or not to be investigated & treated for conditions that won't get worse. For NHS engagement with patients & the public to be meaningful, there has to be an acceptance that taxpayers sometimes can have a powerful influence on what should not be available.
While it's true that 'consultation' is required only for substantial changes, there is a much wider duty on all parts of the NHS to involve patients & the public on all service changes, in S242, which is often overlooked. And larger centres are better only if the evidence is there to show increased volume equates with improved outcomes, not always the case.