Lord Darzi's NHS investigation: IRP submits evidence, highlights shift in reconfiguration trends

Professor Sir Norman Williams, Chair of the IRP, informs Lord Darzi's independent investigation that recent NHS reconfigurations are driven by operational challenges rather than a focus on improving clinical outcomes

The Independent Reconfiguration Panel (IRP) has submitted evidence to Lord Darzi's independent investigation into NHS performance.

The IRP, accountable to the Secretary of State, primarily advises ministers on reconfigurations and changes to NHS services in England. Additionally, they offer informal advice to any parties involved in NHS service changes to help improve policy and practice.

Lord Darzi's 2008 report, Leading Local Change, part of the wider NHS Next Stage Review, stressed that NHS reconfigurations should be clinically driven, locally led, and focused on benefiting patients.

In a letter to Lord Darzi, Professor Sir Norman Williams, Chair of the IRP, acknowledged the NHS has significantly improved in this area, particularly in its approach to involving the public and patients, including using the regional Clinical Senates to support and assure local work.

However, in recent times, there has been a change in the trend due to the significant performance challenges faced by the NHS.

The IRP has observed that “rather than service change being driven by an ambition to improve clinical outcomes, the trend has often been for reconfigurations to emerge from operational necessity such as a lack of NHS staffing to sustain services, as well as the poor condition of NHS estates.”

This issue is particularly evident in the community hospitals, Professor Williams stated in the letter.

Over the past 20 years, the most common type of NHS reconfiguration referred to the IRP has been the major reorganisation of acute hospital care, such as the centralisation of emergency and elective care on separate ‘hot’ and ‘cold’ hospital sites.

Professor Williams noted that these proposals frequently result in the 'downgrade' of a hospital site, replacing the emergency department with an urgent treatment centre, which understandably becomes an emotional and contentious issue for the local community.

The IRP is also concerned about services that were temporarily closed or reconfigured due to staffing issues during the Covid-19 pandemic but remain so years later.

Professor Williams pointed out that these 'temporary reconfigurations' are common in urgent treatment centres and freestanding midwifery-led birth units, restricting access to care and raising concerns about their long-term sustainability.

“The continuing uncertainty around the future of these services is unfair to patients and the NHS staff who work in them,” he said.

Professor Williams stressed the importance of NHS integrated care boards regularly reviewing these ongoing temporary changes and developing long-term plans in collaboration with local system partners and the public.

The IRP has welcomed the new powers introduced via the Health and Care Act 2022, which allow the Secretary of State to intervene in NHS reconfigurations by 'calling in' proposals for a decision and acting as the final arbiter.

“The new legislation presents an opportunity for ministers to take decisions on NHS reconfigurations in a timely manner and ensure progress is made when options for local resolution have been exhausted,” Professor Williams said.

He emphasised that a decision by the Secretary of State to 'call in' a proposal should be seen as a neutral act, allowing ministers to examine concerns raised by stakeholders using a fair process.

Additionally, Professor Williams believes there is potential to streamline the approval process for major capital schemes involving the reconfiguration of NHS services.

The IRP also stresses that NHS reconfiguration proposals should include a meaningful impact assessment that addresses both health and healthcare inequalities.

“Wider factors such as socio-economic deprivation, healthy life expectancy and changes in population demographics can also often be overlooked in NHS reconfiguration planning and need to be considered using a system wide approach,” Professor Williams suggested.

In July, Health Secretary, Wes Streeting, ordered this independent investigation aimed at uncovering the “hard truths” about the “broken” NHS.

The findings from this investigation, which is expected to be completed by September, will provide the basis for the government’s 10-year plan to reform the NHS.