The reconfiguration of clinical services. What is the evidence?

Title of driver: The reconfiguration of clinical services. What is the evidence?

Source:  The Kings Fund

Link to main document:

Publication format:  PDF

Date of publication: November 2014

Summary of driver:

This paper builds on the analysis of reviews of service reconfigurations commissioned by the National Institute of Health Research and conducted by the National Clinical Advisory Team.

A majority of specialist services are now commissioned by NHS England and there is an assumption that service reconfiguration will deliver substantial savings. This paper has concerns about the quality of evidence available to guide the reconfiguration of clinical services. Whilst the evidence available does not suggest that service reconfiguration will deliver significant savings, the evidence does imply that improvements in quality could be achieved.

The paper sets out policy and service context across 13 clinical service areas and the key drivers for change evident for reconfiguration by summarising the research evidence and professional guidance available.

Key features of driver:

  • Paper identifies five key drivers of reconfiguration –quality, workforce, finance, access and technology.
  • There is no ‘optimal design’ for any service. Reconfiguration will depend on local context and the balance between the five main drivers listed above.
  • Each clinical service area is divided into the following sections: what changes were being proposed?, key drivers, context and relevant policy, evidence that needs to be taken into account when reconfiguring the relevant service, key clinical and service interdependencies and finally, the relevant college guidance.
  • Technology can reduce the need to travel, provide quicker diagnosis and has potential to deliver clinical services more effectively.
  • Delivering improvement will require new ways of working such as minimum hours for consultant cover and non-medical staff being utilised in different ways to provide safe patient care. The concept of ‘what’ staff do as opposed to ‘who’ is a recurring theme.
  • Change needs to be as evidence-based as possible.

Primary audience: Senior NHS and healthcare management, leaders in health and social care.

Impact on library policy/practice: No direct impact identified. Possible rise in requests for information on changes in working patterns or service delivery.

Date last updated: April 2015

Due for review:  April 2016

Group member responsible: LK

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