Junior health minister Lord Darzi is to tell primary care trusts they can reconfigure local services only where they can prove it will save lives or improve health outcomes.

In a “framing document” to be published tomorrow, the minister is expected to set out a list of rules PCTs will have to adhere to when they want to reconfigure services.

This document will lay the ground for the reports strategic health authorities will publish in the next few weeks, in which they will set out regional priorities, likely to include proposed service changes. The SHAs’ reports will feed into the final report from Lord Darzi’s next stage review, due by July.

The rules will include giving clinicians a leading role in managing reform. PCTs will be able to consult on proposed changes only once there has been a clinical review, so they are clear with the public that they are consulting on changes with a clinical evidence base.

The document is intended to serve as a robust set of guarantees for the public and NHS staff.

HSJ understands there will also be a requirement that old services can be removed only once new ones are in place.

However, Lord Darzi will stress that health services such as stroke and trauma do need to alter - that there should be no moratorium on change. He is likely to say that his proposals should lead to “better change” rather than more change.

The minister is understood to believe that the public is not opposed to change but wants to know services are being “streamlined rather than undermined”. The new rules are intended to make that clear.

The report is expected to say the role for the Department of Health will be to bring together and share clinical evidence on particular services. It will then be up to local clinical groups to make decisions on how best to apply the evidence locally.

The new framework formalises many of the intentions Lord Darzi set out in his interim report in October, when he promised to raise the standard of evidence expected before change takes place and to ensure that local decision making processes were “subject to greater public and clinical scrutiny, including by ensuring that the local case for change is led by clinicians”.

The case for change: Darzi’s new document

  • Clinicians will propose how services should change locally.

  • Primary care trusts will not be able to consult on reconfiguration of services until there has been a clinical review giving evidence of the benefits.

  • PCTs must guarantee that old services will remain in place until new ones are ready.

  • The politics will be removed: the Department of Health’s only role will be to provide an account of clinical evidence.

  • There must be no moratorium on change.

For more analysis, see this week’s leader