The 2006 National Health Service (NHS) white paper, Our health, our care, our say, set out a strategy to provide more services in the community, closer to people's homes.1 The report of the evaluation has just been published,2 along with a report from the specialties involved.3 The strategy was based on international experience that moving care from large hospitals to smaller local sites improves patient satisfaction and outcomes and is more cost effective. The scheme involves new and more integrated care pathways, polyclinics that provide a wide range of diagnostic and therapeutic services,4 and renewed investment in community hospitals. Plurality of services, and the system of “payment by results” by which money follows patients, should enhance patient choice and incentivise quality and value.5

The white paper included a commitment to evaluate the strategy in 30 “closer to home” demonstration sites in six specialties: dermatology; ear, nose, and throat; general surgery; gynaecology; orthopaedics; and urology. The services provided by the demonstration sites …