The reconfiguration of hospital services: is there evidence to guide us?

Abstract

Many argue that the solution to the NHS’s quality and fi nancial problems lies in the continuing reconfi guration and centralisation of hospital services. However, an ageing population requires good local access to care. This paper reviews the evidence that is available to help guide the reconfiguration of hospital services. The quality overall is poor and, in particular, there is little evidence that reconfi guring hospital services results in fi nancial savings. For acute medical care, there is strong evidence both for enhanced direct and early consultant involvement, and for the importance of comprehensive supporting services. Clinical networks and new technologies may offer opportunities to sustain local access but more evidence is needed to guide network development and to ensure safe but sustainable medical staffing models.