The Future of Service Reconfiguration: Early Signs of Movement

After a prolonged period of inertia, there are now tentative indications that service reconfiguration across the NHS may finally be gathering pace — albeit more of a cautious murmur.

For some time, there has been a growing expectation that the scale of challenges facing the NHS — along with where we are in the broader political cycle — would inevitably catalyse a significant increase in reconfiguration activity. Yet little of that anticipated momentum has materialised. Until now.

The decision this month by Health Secretary Wes Streeting not to intervene in eight service reconfiguration proposals may represent a subtle yet significant shift in tone and trajectory. Some of these schemes had languished in ministerial in-trays, for well over a year, with little sign of progress. Their quiet approval may now serve as a starting gun for wider reform, being read as a signal that, provided due process is followed and the case is sound, local systems can proceed without undue fear of political derailment.

That said, the Secretary of State referral mechanism continues to cast a long shadow, introducing political complexity and local sensitivities into the mix.

Some of the reconfigurations in question — such as the closure of the hyper-acute stroke unit (HASU) at Yeovil, or the longstanding issues surrounding Teignmouth Community Hospital — have been years in the making, primarily driven by concerns around clinical sustainability and workforce constraints. Others, such as the situation at the Norfolk GP surgery or Chiltern Court beds, highlight how newly conferred ministerial powers are reshaping the referral landscape — and how local relationships, especially with Health Overview and Scrutiny Committees (HOSCs), now play a more pivotal role in shaping outcomes.

 It’s notable that not all eight cases would have triggered referral under the previous regulatory framework. While the threshold for central intervention appears to have risen, the Secretary of State is showing a greater willingness to stand back, provided due process has been observed and local engagement — particularly with HOSCs — is handled well.

However, the real test lies ahead. The proposed centralisation of acute and emergency services by the Humber and North Yorkshire Integrated Care Board (ICB) — encompassing Grimsby and Scunthorpe — is conspicuously absent from the list of approvals. Whether this scheme is called in or allowed to proceed may prove the clearest indication yet of how committed the current government is to genuine local leadership in service change, particularly in an era of constrained capacity.

Simon Angelides