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Reconfiguration rules held up three months after system reformed

The government has refused to publish guidance which has been prepared on how service reconfiguration could be planned in the new NHS system, more than three months after the reforms took effect.

It comes amid confusion about organisations’ roles in leading major service change.

The Department of Health commissioned a review of guidance on how major service changes should be planned and carried out late last year.

It was carried out by former NHS South West chief executive Sir Ian Carruthers and recommendations were submitted to the DH early this year.

However, it has never been published. An HSJ freedom of information request to the DH for Sir Ian’s review has been rejected.

NHS England said in April it would “develop and oversee a framework” for major reconfigurations, work which was expected to build on Sir Ian’s recommendations.

However, HSJ understands there is no date set for publication of this work, and that it is facing delays.

One senior commissioning source said this was likely to be due to concern it could be seen as a “green light for reconfiguration”, and therefore be politically controversial.

Many NHS leaders have identified the need for major changes to make savings, and confusion in the reformed system about which organisations are able to lead it.

An HSJ survey of 94 CCG leaders in May found 51 per cent believed “CCGs are leaders of [reconfiguration] jointly and equally with each other. NHS England will contribute along with other partners”.

However, 30 per cent said NHS England and CCGs were “joint leaders of the work” and 7 per cent that “NHS England is the convener of the work, with CCGs as partners”. There is also a potential conflict between commissioners’ role and Monitor’s licensing and administration regimes.

NHS Confederation chief executive Mike Farrar told HSJ: “It is really important there is a shared script on service reconfiguration. It there isn’t it is going to hold [change] up even further.

“It would be good for work on this to see the light of day.”

Mr Farrar said the growing transfer of funds from the NHS to social care, “requires resources to be moved from the acute sector into better settings”, which would require major service change.

The DH’s reply to HSJ’s FOI request said: “Sir Ian provided a number of high level recommendations that require further detailed discussions between the [DH] and its partners to translate these into operational practice.

“One of Sir Ian’s recommendations was that, due to the level of organisational change taking place across the system during the final quarter of 2012-13, there should be further detailed work with the new bodies that were formed from April.”

Readers' comments (6)

  • s36 exemption i presume?

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  • For all the talk of private sector efficiency, we dont seem to want to take a leaf from industry's book on managing major change.

    We have a process with so many landmines in it, it can take years, millions in (unavailable) management cost, and still result in higher death rates due to opponents using process failures.

    No way will we hit the £20bn or the new £30bn challenge without reforming all of this.

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  • Interesting take on transparency ie only when it suits the government.

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  • The new system is a long, long way from even understanding how it goes about major service reconfiguration....we are a million years away from actualy delivering the sort of reconfiguration that is needed. I feel all hope is gone.

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  • What were the grounds under which the FOI request was rejected?

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  • The case for reconfiguration rests on several myths:
    1.That 50% of A&E attendances can be diverted into the community.
    2. That expansion of primary and community services will reduce demand for acute services to an extent greater than the investment in primary and community services
    3.That the costs of creating capacity in new centralised facilities will be less costly than the savings from reducing local services.
    4. That local people will not notice the difference and will not vigorously oppose reductions to access, capacity and resilience of local services.
    5. That there are not simpler, safer and less costly options for improving staffing levels and safety in acute settings.
    6. That those asking for a proper business case before agreeing to reconfigurations are being obstructive and difficult.
    7.That it is vital to push reconfigurations through before the next election.
    8. That there are not other options for achieving savings to meet efficiency targets.

    Can someone point to the evidence supporting any of these myths?.

    "Sir Ian’s recommendations was that, due to the level of organisational change taking place across the system during the final quarter of 2012-13, there should be further detailed work with the new bodies that were formed from April.”

    This seems eminently sensible to me.

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