Intended for healthcare professionals


Hospital service reconfiguration: the battle for hearts and minds

BMJ 2012; 344 doi: (Published 16 February 2012) Cite this as: BMJ 2012;344:e953
  1. Helen Barratt, research training fellow,
  2. Rosalind Raine, professor of health care evaluation
  1. 1Centre of Applied Health Research, University College London, London WC1E 6BT, UK
  1. Correspondence to: H Barratt h.barratt{at}

Will Andrew Lansley’s four tests for reconfiguration make decisions less controversial? Helen Barratt and Rosalind Raine discuss the challenges they raise

Proposals to reconfigure NHS hospital services are always contentious. In 2001, Dr Richard Taylor won a parliamentary seat on the strength of his campaign against the decision to close acute services at Kidderminster Hospital.1 More recently, plans to centralise surgical services for children with congenital heart disease have prompted opposition across the country.2 The Independent Reconfiguration Panel (IRP) advises ministers about re-shaping hospital services and, by the end of 2010 it had undertaken 17 full reviews of contested proposals for health service change in England and offered written advice on several others.3

During the 2010 general election campaign, the Conservative party promised to stop “centrally dictated” reorganisations of NHS services.4 Writing in the Daily Telegraph on 21 May 2010,5 days after the coalition government came to power, the Secretary of State for Health, Andrew Lansley, declared a moratorium on such programmes. All proposals—even those at the implementation stage—were put on hold and planners were instructed to demonstrate that plans met four new tests: support from general practitioner (GP) commissioners, strengthened public engagement, consistency with patient choice, and clear evidence for change.

One high profile reconfiguration affected by the moratorium was the proposed downgrade of acute services at Chase Farm Hospital in north London (box). We provided academic input to the review of these proposals. In this article, we draw on this experience to reflect on the difficulties of applying the Lansley tests and propose ways to strengthen the evidence base to aid decision making.

Chase Farm reconfiguration

Proposals to downgrade services at Chase Farm Hospital in north London were first raised more than 15 years ago.6 They included replacement of the emergency department with an urgent …

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