Published: 31/10/2002, Volume II2, No. 5829 Page 5

A draft Department of Health framework document on hospital reconfigurations, seen by HSJ, will say they must be based on 'socially sustainable decision-making' and services designed 'with local populations, not for them'.

The government has been anxious to avoid the sort of controversy that led voters in Wyre Forest to unseat a government minister and elect hospital campaigner Dr Richard Taylor in protest at the downgrading of Kidderminster General Hospital.

The draft framework document says reconfiguration has 'become synonymous for many local communities with the loss of services, especially highly valued 24-hour emergency services, through closure and centralisation. In some places, the process has generated significant tensions between local health services and the communities they serve.'

Instead, the 'central aim' of the new approach 'is socially sustainable decision-making'. This demands 'a fundamental change in the way the options are assessed', the document says. 'The priorities of communities will not always coincide with those of NHS managers and clinicians. Their views about the relative importance of risks, costs and benefits may differ.'

The document acknowledges the constraints of patient safety, workforce and resource issues, but says: 'Within these limits, the views of local communities and their elected representatives should carry equal weight to those of NHS organisations.'

The framework calls for a 'proactive' approach to redevelopment where 'sustaining and improving local access to services must be at the heart of the quality debate'.

'One specific aim of the project was to find sustainable solutions for smaller hospitals.'

The framework 'is not a detailed manual for service change', it says, instead outlining examples of new configurations being tried in Bishop Auckland, Central Middlesex Hospital and West Cornwall.

It describes two 'sharply differing scenarios'. Services which are highly specialised - receiving seriously ill patients around the clock and/or caring for medically unstable patients - tend towards centralisation. Those offering daytime services and overnight care only for medically stable patients were more likely to be subject to 'localisation', it suggests.