Trusts and strategic health authorities must 'raise the bar' on the quality of local service consultations, says Sir Ian Carruthers in his national review of current reconfiguration proposals.

Although the review does not name individual consultations or say how many succeeded or failed, Sir Ian said the poorest performers were below the standard he would expect.

The NHS South West chief executive told HSJ: 'We weren't passing and failing schemes - that is the decision of the local NHS; we were looking at the process. The good were very good but we could do a better in a lot of instances. It will be the role of the SHA to assure the department that the best practice in here is adhered to.'

The draft letter presented to the DoH management board on Tuesday and due to be published yesterday says that it has 'set out the standards all SHAs and trusts should aspire to'.

'The bar is already high, but we should set it even higher,' it says. It recommends SHAs introduce a system of quality assuring proposals - similar to that used by the Office of Government Commerce for major public-sector procurement exercises - which would ensure that they were planned properly and fitted with national policy priorities.

An appendix sets out a framework which the letter says should be used by SHAs and trusts preparing for service consultations.

The letter also says primary care trusts should take a central role in leading reconfiguration. 'PCTs should normally lead the preparation and consultation on service improvement proposals,' it says.

The review found high variation in the manner and success of reconfiguration consultations, even within the same area. Sir Ian said: 'The detail, style, format [and] language of consultation documents varies too much. When you read a lot of them, it is not clear what is being discussed.'

He was also critical of the excessive time taken by some consultations and urged trusts to be more realistic about the investment needed. His review stresses the need for clinical involvement at an early stage, co-ordination between reviews in the same area, a solid and fully agreed business case, closer involvement of the board and a proactive attitude to the media.

Sir Ian said 'a lack of noise' around a consultation should not be taken as a sign of success. 'There is going to be noise, these changes are controversial and it's absolutely right for the public to be involved.'

Download the letter