Health secretary Andrew Lansley has said care settings will only “rarely” have to be closed but insisted he will back commissioners who show leadership and take difficult decisions on reconfiguration.

Mr Lansley was speaking late yesterday afternoon at the Commissioning Show in London. It was his first major speech since he personally placed South London Healthcare Trust into administration, applying the failure regime for NHS trusts for the first time.

He told delegates that sometimes improving services will involve taking difficult decisions. “Sometimes improving outcomes means reorganising services - focusing services in a smaller number of centres of excellence; sometimes not delivering services further from people but closer to people; [or sometimes moving to] services which are out of hospitals but in the community, in people’s homes.

“While rarely will care settings close down, many will see their roles change. Sometimes that change will be significant and difficult. We know for example that some hospitals where change is needed - hospitals with longstanding problems that can no longer be swept under the carpet. 

“We can’t just keep kicking the can down the road, diverting hundreds of millions of pounds away from patient care, to cover up deficits.”

He said strong leadership will be called for, “but we will help”.  “I’m not asking you [commissioners] to use your budgets to provide for the deficits of the providers in your local health economy… what we’re aiming to do, is as quickly as we can, to make sure that people start out with the problems of the past properly dealt with.”

“We are still intending that you should start in April 2013 with no legacy debts. That won’t be true in the provider sector but it will be true for commissioners.”

Mr Lansley said this meant that “decisions will need to be made, and bullets will have to be bitten”. 

He said if commissioners led the case for change locally, backed by evidence, “I will back you”. 

The Department of Health will publish its draft mandate for the NHS Commissioning Board late next week. Mr Lansley said the document will “embody the values of the NHS - a free, comprehensive service, available to all, based on need, not ability to pay. Not a rationed service”. 

However - he added: “It has to be a service that is clear about clinical effectiveness. We are not asking [commissioners] to offer treatments of no clinical benefits, or those which are of poor value.”