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Exposing the myth that reconfiguration of clinical services improves quality and saves money

BMJ 2014; 349 doi: (Published 26 November 2014) Cite this as: BMJ 2014;349:g7172
  1. Peter Davies, freelance journalist, London, UK
  1. petergdavies{at}

Big may be better for some clinical services such as stroke but, for the most part, reconfiguration causes lots of angst for little or no quality or financial gains, finds a new report by a leading think tank. Peter Davies reports

Nothing in the NHS has the potential to cause prolonged uproar more than a proposal to reconfigure clinical services. Recall how a plan to close Kidderminster Hospital’s emergency department in 2001 led to a government minister losing his seat and being replaced as the local MP by a retired consultant physician standing as an independent.1 Consider how last year campaigners to preserve services at Lewisham Hospital, south London, won a high court ruling that the secretary of state had acted unlawfully.2 Contemplate the controversy brewing in Staffordshire as clinical commissioning groups move to reorganise cancer services, possibly giving a major role to the private sector.3

In a service struggling to meet rising demand, adopt new treatments and technology, and cope with a burgeoning financial gap, policy makers tell professionals that reconfiguring clinical services will be an inescapable way of life for the foreseeable future—despite the inevitable angst. Usually such plans involve centralising services on fewer sites and closing small hospitals. Shifting services to primary care or the community will, it …

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