This site is intended for health professionals only

Blog: Considering Service Reconfiguration

21 January 2015

The Five-Year Forward View sets out a vision of change within the NHS. The potential implications for service reconfiguration could be radical and far-reaching

The Five-Year Forward View sets out a vision of change within the NHS. The potential implications for service reconfiguration could be radical and far-reaching

The field of service reconfiguration has been subject to significant change during the last ten years.  Until the introduction of the NHS Four Lansley Tests (2010), local health economies had been responsible for determining and assuring service reconfiguration.  For the first time, the Four Tests, described the way in which commissioners and regulators should consider service change proposals. 

This framework has since been further developed by NHS England with the publication of its comprehensive framework of assurance, ‘Planning and delivering service changes for patients’ (2013).  Over the same period, other areas such as public engagement, procurement and competition have contributed to a developing assurance landscape.  For commissioners and the local health economies they support, these changes have created a more complex and challenging environment in which to develop service reconfiguration proposals.  

In response to this, local health economies have broadly adopted two differing models when considering how to develop their clinical services.   Some local health economies have opted to reconfigure clinical services as an ongoing strategy, often addressing a single clinical specialism.  Other local health economies have developed multi-site programmes addressing multiple clinical specialisms across a larger geographical area.  These are complex programmes working with a number of commissioners and providers.

Whilst all of these programmes can have radically different characteristics, strong clinical leadership is a core theme of success.  Clinical leadership provides the central pillar for any service reconfiguration programme’s decision making.  It is also fundamental in helping build public confidence and engagement in the supporting processes. 

Clinical leadership is not without its challenges, however.  It must balance a range of competing needs, either in terms of clinical resources, or in considering patient access versus improved outcomes.  Successful clinical leadership should consider a range of often conflicting views, with a clear focus on the decisions that need to be made.

A realistic assessment of the cost, time and resources involved in developing and approving proposals is also key to successful service reorganisation.  Local health systems often have ambitious plans for the development of and engagement in service reconfiguration proposals.  These can fall short of adequately understanding the complexity or interdependence of the service change or the need for proposals to be delivered against a background of economic austerity. 

Finally, service reconfiguration plans need to be developed in the context of ever-greater public interest in changes to clinical services.  Wide and meaningful public engagement requires time and resources, which must be factored into any plans from the outset.

By Simon Angelides, Reconfiguration Programme Director – NHS Arden & GEM Commissioning Support Unit

NHS Arden & GEM CSU and NHS IQ are running a series of three ‘Navigating Essential Change’ Webinars. The series considers some of the key questions that need to be answered when thinking about establishing a service reconfiguration programme. 

The second webinar is on the 22nd January (10.00am). To take part, email: [email protected]. To listen to previous webinars visit

Want news like this straight to your inbox?

Related articles