Website of the Department of Health
Please note that this website has a UK government access keys system.
Page menu
You are here:
Frequently asked questions
-
Last modified date:29 August 2007
General questions about hospital configurations and reconfigurations, with specific references to Keeping the NHS Local: A New Direction of Travel, the consultation responses and the evidence file.
General information
Q. What is Keeping the NHS Local for?
A. This document sets out new guidance for the NHS on service change. It will help the local NHS to work in a new stronger partnership with the public and staff to find high quality, sustainable solutions for local services, and deliver the agenda for reform. This document also describes some service models, which were for consultation, to promote further discussion and debate. The consultation period ended on 14th May 2003. They were not intended to be a restricted menu of options - but illustrations of the kind of innovative, locally-tailored models that can be developed by following the core reconfiguration principles.
Q. What is different about the approach set out in Keeping the NHS Local?
A. When considering service expansion and redesign, there are three core principles to be followed:
- developing options for change with people, not for them, starting from the patient experience and our commitment to improve choice, and working with staff to develop new ways of delivering services;
- focus on redesign not relocate. Redesign can offer a high quality alternative to relocating services, extending the range of options for developing new configurations that meet local needs and expectations;
- taking a whole systems view: the NHS needs to exploit the contributions of different hospitals, primary, intermediate and social care providers within a whole systems approach. These providers can expand the range of options available to meet centralising pressures by working in partnership, with genuine integration and joint planning of services.
Q. How will this document help local NHS services?
A. A capacity planning exercise has shown that the NHS is developing a whole system approach to modernisation as a means of improving services and reducing waiting times. It is recognised by the service that doing more of the same is not an option. Therefore, Keeping the NHS Local outlines an approach to local service design and consultation that reflects both the new requirements for partnership, the "closer to home"
model of care supported by the National Beds Inquiry and the new opportunities generated by service and workforce modernisation. It also outlines some of the modernisation strategies available to help provide high quality patient-focused care while ensuring that all staff, including doctors, are supported to work safely without excessive workloads. The guidance proposes sustainable solutions for smaller hospitals to secure their valued role at the heart of local communities. Service and workforce redesign offer the potential for a wider range of safe, effective, high-quality care to be offered in smaller hospitals that has previously been thought possible.
Q. How will this guidance affect places that are considering service change?
A. It will help the local NHS to work in a new stronger partnership with the public and staff to find high quality, sustainable solutions for local services, and deliver the agenda for reform. Building a consensus behind plans for service change can present a major challenge for health services and their local populations. The core principles set out here present a powerful framework to help local partners work together. The Independent Reconfiguration Panel (IRP) will be using this guidance in considering their advice to Ministers on contested proposals for service change.
Q. The whole hospitals models are new - are they being tested?
A. Whilst these examples have yet to be fully tested and evaluated, they will still be useful to inform and stimulate thinking for those who are considering service redesign. The Department has a contract with The National Co-ordinating Centre for NHS Service Delivery and Organisation R&D to develop research specifications for the pilot sites and will therefore have a full evaluation in place.
Q. So we will have to wait until the pilots have been evaluated before anyone else can try out these ideas?
A. No, not at all. Many places are already trying new and different ways of working with great success, and more are being tested through the Working Time Directive pilots. There are some specific new elements - such as the way the local assessment unit will work through a telemedicine link - that do need thorough testing, but many of the other ideas just need to be thought through carefully and adapted to the local context. We have found there to be a consensus that the ideas are the right way forward, and the pilots are an opportunity to look carefully at how these ideas can be implemented effectively, with dissemination of useful lessons across the NHS. And, of course, the new duty to involve and consult patients came into force on January 1 2003, so all local health services need to be working differently with local people and patients from now on.
Q. Does this mean no more small hospitals will close?
A. The starting point should be to look for solutions to improve the quality of patient care and maintain local access to services wherever possible. This will necessitate new ways of delivering services and of structuring the staffing levels needed for those services. There may be times when a hospital cannot continue to provide the full range of services that it has done up to now, but this document shows that creative new approaches can deliver sustainable, locally accessible hospital care. And smaller hospitals, even those which may lose some aspects of the services they currently provide, may well be able to provide a different and wider range of services in the future - for example outpatient appointments or day surgery.
Q. There is lots of useful general information here, but what about other services such as maternity and paediatrics?
A. The principles and the ideas and individual examples of how services can be redesigned by using the workforce differently should be applicable to any service. Additionally, further work has been undertaken by the Modernisation Agency to identify models of good practice in paediatrics and maternity services. The report on Children's Services features a range of models and approaches to achieving WTD compliance in children's services. This report can be found on the MA's website.
Q. Is there special funding available for reconfiguration and redesign?
A. Not normally. The continuing development of future plans for services is part of the core business of health organisations.
Q. This is quite a change from how configuration has been dealt with in the past - is there any assistance available on how to use this new approach?
A. There is limited support and guidance available from the new team at the Modernisation Agency and the person to contact is Chris Howgrave-Graham. He can be contacted via email on chris.howgrave-graham@dh.gsi.gov.uk.
There is also a page on "Further Sources of Reference"
in this section where you will find a list of references that are mentioned in the document. This list summaries the references and points you to the website where further information can be found.
The Modernisation Agency has a wide range of programmes and initiatives to support organisations redesigning services. In particular, the Changing Workforce Programme has a useful website that has a toolkit for local change and a role design database which organisations may find useful.
The NHS Confederation has established a 'Future Healthcare Network', bringing together health organisations engaged in planning major change.
Q. How is the European Working Time Directive (EWTD) relevant to this document?
A. The extension of the EWTD to doctors in training that came into force in August 2004 presents a major challenge to the service. Historically, doctors in training have worked long hours and provided much of the out of hours medical cover. Considerable progress has been made in reducing hours through the 'New Deal' but the EWTD imposes more stringent requirements. Implementing the EWTD and reducing the hours of doctors in training is much more than just a human resources issue as it requires innovative approaches to how services are staffed and provided, particularly in those services, which require 24-hour emergency medical cover. It is important that future service models allow working patterns that are compliant with the EWTD, and achieving this has been taken as a given in developing the document.
Pilot sites and evaluation
Q. What was the rationale behind the selection of pilots?
A. The pilots are ones that are already involved in leading change or they are about to start a review, which is likely to lead to different models of care and possibly reconfiguration of services.
Q. The whole hospitals models are new - are they being tested?
A. These examples are yet to be tested and may be used to inform and stimulate thinking for those who are considering service redesign. A full evaluation programme has been established through the National Co-ordinating Centre for NHS Service Delivery and Organisation R&D to look at the pilots in depth.
Q. Can I contact the pilot directly to ask specific questions?
A. We are asking you not to contact the sites directly in the first instance. Their work is in very early developmental stages. Information about the pilots is set out in the profiles on this website. As soon as more information becomes available about the pilots, we will share it with the service.
Q. How will we know if the pilots have been successful?
A. The evaluation is being commissioned by the National Co-ordinating Centre for NHS Service Delivery and Organisation R&D (NCCSDO).
Q. How will the lessons from the pilot sites be disseminated?
A. Lessons from the live pilots will be incorporated into the various support mechanisms available to local areas, including the Strategic Health Authorities and the Modernisation Agency
Q. Have international models been considered?
A. An Evidence File was published in July 2004 that summaries both the published literature on the service models, and lists a range of examples of good practice from the NHS and elsewhere which support Keeping the NHS Local approach.
Access keys
