Published: June 2020
Author: Liz Knight
Significant changes to the configuration of health services have historically been a long and often tortuous process. And unfortunately, they can end up falling apart due to changes in priorities, changes in leadership, or ongoing public appeals. Take as an example, the withdrawal of support by the Department of Health and Social Care, NHS England and NHS Improvement for changes to the urgent and emergency care at Ealing Hospital and Charing Cross Hospital in March 2019, 7 years after the plans were originally published. Or reconfiguring Kent and Medway’s stroke services where efforts to review the current model of care began back in 2014, a final decision was made to establish three hyper acute stroke units in 2019 but it is yet to be implemented as legal appeals are still ongoing.
Despite these common challenges, the NHS’ response to COVID-19 has seen the rapid reorganisation of many services delivering transformations and improvements. For example, the doubling of critical care capacity, the consolidation of elective services onto ‘COVID-free’ sites and the temporary closure or movement of many urgent hospital services, including A&E and stroke.
There are local ambitions in many areas to make changes permanent, with some policy shifts taking place to support this. For example, in London on 24 April 2020, NHS England and NHS Improvement introduced a new policy through the paper Journey to a New Health and Care System. The paper stated changes made to tackle COVID-19 cannot be undone without the permission of NHS England and NHS Improvement. The rationale provided for this new rule was to help reduce the risk of institutions optimising from an institution point of view rather than an Integrated Care System point of view, but regardless, the effect is still the same – temporary changes will be maintained for longer.
That being said, under the current legislation of the NHS Act 2006, significant changes to health services cannot be made permanent without full public and local authority consultation. This prevents any irreversible changes taking place such as construction projects or staff redundancies.
Although the NHS is currently being given a lot of latitude because of COVID-19, this is likely to change as local communities realise there may be no plans to reverse changes in services which they have been fighting to keep. It is also unlikely that consultations will be able to take place until 2021 at the earliest as consultation on closing NHS services in middle of the COVID-19 crisis seems unlikely to land well. The approach to conducting consultations may also have to be reviewed if the traditional large gatherings of people to discuss proposed changes are still forbidden or considered unsafe particularly for the more vulnerable patient stakeholders.
This means one of two things will need to take place in the future to permanently embed COVID-19 reconfigurations. Either areas will need to conduct a full consultation at a much later date (and without making any irreversible changes in the meantime), or legislation will have to be changed to allow a slimmed down process, thereby reducing the time required. It will be interesting to see how this plays out over the coming months, especially given the determination to leverage the benefits of changes that have taken place as a result of COVID.