A fifth of all planned surgery should be concentrated at specialist hospitals, according to a report by Professor Sir Ara Darzi, the national adviser on surgery.

Outlining the future of planned surgery for the first time, the Department of Health report calls for an '80/20 split', with 80 per cent of surgery carried out locally, mainly as day cases and short stays.

The remaining elective surgery will be performed at specialist centres, which will be created through extensive service reconfiguration.

Sir Ara Darzi's report, Saws and Scalpels to Lasers and Robots - advances in surgery, says some of the 80 per cent of local surgery could be delivered in health centres and large GP practices. The report concludes that 'services the NHS offers must change', a view echoed by health secretary Patricia Hewitt in a speech to the Royal College of Surgeons on Tuesday.

She said advances in medicine and surgery were leading the DoH's reconfiguration drive - and not ministers' need to tackle deficits.

But NHS deficits had 'got completely muddled up with issues about reconfiguration' and she admitted that some trusts had come up with service changes 'as almost a panic response'.

This 'damaged public confidence and made it more difficult to have sensible discussions', she said.

Key to winning public confidence is bringing doctors on board to endorse service changes, Ms Hewitt said. 'If it's hard for a clinician to make that case to the public it is well nigh impossible for a minister or even a committed NHS manager to make that case.'

Ms Hewitt also announced that managers would be given access to a 'national clinical advisory team' led by Professor George Alberti, the national director for emergency access.

The pool of clinical experts, which includes a number of national clinical directors and other senior doctors, will lend their support to proposed service changes, or suggest adjustments to proposals.

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