Performance challenges driving NHS reconfigurations

The chair of the Independent Reconfiguration Panel (IRP) says it has observed a “trend” for reconfigurations to emerge from operational “necessity” such as a lack of NHS staffing as well as the “poor condition” of NHS estates, due to the “significant” performances challenges faced by the NHS.?

The IRP which advises ministers on large-scale changes to clinical services published its evidence to the Darzi review on NHS performance earlier this month.

IPR chair Professor Sir Norman Williams explains that while the NHS has got better at involving the public and patients and using the regional Clinical Senates to support and assure local service change, it is not being clinically driven, locally led and to the benefit of patients. Instead, financial challenges, workforce shortages and aging infrastructure are now driving service reconfigurations particularly seen within community hospitals.

Most common IRP referral

The reorganisation of acute hospital care to centralise emergency and elective care is also criticised often justified it says on “clinical necessity and a means to resolving staffing issues, even when it presents a risk to access for patients and may negatively impact the patient experience, often with regards to travel, transport and ambulance conveyance times.”

Lack of clarity around the future of ‘temporary reconfigurations’

There is also concern about the number of overnight or full closures of NHS services initially intended as temporary measures during the Covid-19 pandemic, such as urgent treatment centres and midwifery-led birth units. The continuing uncertainty around the future of these service impacts staff and patient. The IRP would like to see Integrated Care Boards review these services and develop a long-term plan with stakeholders in their local Integrated Care System.

New ministerial intervention powers

The IRP welcomes the ICB’s role in leading locally driven decision-making on NHS service change, but also supports the introduction of new ministerial powers under the Health and Care Act 2022 to intervene in NHS reconfigurations by ‘calling in’ any proposal for decision. For example, where there is wider regional or national significance or profound disagreement among stakeholders. Interestingly, the IRP view any decision to ‘call in’ a proposal as a ‘neutral act’ to allow ministers to review concerns with an ‘open mind, using a fair process’.

However, the Department of Health and Social Care guidance says that it “expects these only to be used in exceptional situations where local resolution has not been reached”. Read our summary of the guidance here.

Greater scope for streamlining approvals

The IRP calls for “a single end to end decision making process for major capital schemes that involve the reconfiguration of NHS services.” This it says would reduce the ‘double handling’ in the decision-making process and avoid the creation of multiple business cases, some of which duplicate information and must pass through both NHS England’s reconfiguration assurance processes, as well as a separate government capital approvals process, including the Joint Investment Committee for NHS England and the Department of Health and Social Care.

Broadening impact assessments

Current impact assessments address health inequalities but the IRP consider it ‘vital’ to also consider the impact on ‘healthcare inequalities’ covering timely access to healthcare, the patient experience and health outcomes. It explains that other factors such as socio-economic deprivation, healthy life expectancy and changes in population demographics are often forgotten in NHS reconfiguration planning.

NHS estates

As one of the issues highlighted as a driver for service change, the British Property Federation’s recent report calls on the government to review the current NHS funding system to enable private capital to address the NHS maintenance backlog, update existing estates and invest in new buildings.

As for the Conservatives’ flagship new hospital scheme to build or expand 40 hospitals, we are currently awaiting the government’s review which is already suffering delays due to lack of funding. This has also prompted concerns that redevelopment work and the removal of ?reinforced autoclaved aerated concrete from hospitals has been stalled. We understand further details will be set out in next month’s Budget.