The Independent Reconfiguration Panel (IRP) has published its evidence submission to Lord Darzi’s independent investigation of NHS performance commissioned by the Secretary of State for Health and Social Care Wes Streeting. Lord Darzi’s review will provide the basis for the government’s 10-year plan for NHS reform, and its rapid assessment is expected to be delivered this month (September).
In the IRP’s evidence submission, Chair Sir Norman Williams questions whether reconfiguration decisions are always in the best interests of patients, pointing out that Lord Darzi’s own report of 2008, ‘Leading Local Change’ highlights that NHS reconfigurations should be “clinically driven, locally led and always to the benefit of patients.” Instead, the IRP feels “operational necessity,” such as crumbling hospital buildings and staff shortages, often drives decisions.
This, it observes, is particularly the case within community hospitals. However, the reorganisation of acute hospital estates over the last 20 years to centralise emergency and elective care, is also criticised. Such moves, the IRP says, are often justified as: “a clinical necessity and a means of resolving staffing issues, even when it presents a risk to access for patients and may negatively impact the patient experience.”
Welcome interventions
The IRP welcomes the locally-led decision making on service changes that are heralded through Integrated Care Boards, but also supports the introduction of new powers via the Health and Care Act 2022 to allow ministerial intervention, for instance, where there is so much disagreement among local stakeholders that a resolution is not possible.
More streamlining
The IRP also calls for: “a single, end to end decision making process for major capital schemes that involve the reconfiguration of NHS services.” This would remove the current duplication of information, the need to create multiple business cases and pass through two separate assurance and approval processes.
