The Future of Service Reconfiguration: Lessons from the Field

Written by Baxendale Team | 09/05/25 08:19

In part one of this two part blog series ‘The Future of Service Reconfiguration: Early Signs of Movement’ we discussed the indications that service reconfiguration across the NHS may finally be gathering pace following the Health Secretary's decision not to intervene in some proposals.

Taking a closer look at the eight cases that proceeded without intervention, and drawing on insights from the AYLI and ourselves, several key themes and considerations have emerged for systems contemplating change.

1. Competency in Process Is Non-Negotiable
Those close to the recent eight cases are clear: if a system is competent, it should be capable of withstanding judicial scrutiny. But competence cannot be taken for granted. Clear documentation, meaningful engagement, a robust clinical case, and strict adherence to NHS England’s assurance process are all essential. These elements are the foundation — not a safety net.

2. The Secretary of State’s Role Is Evolving
Streeting’s approach thus far appears pragmatic rather than detached. While signalling an appetite for greater reform, he has also indicated a preference for local systems to manage change themselves — with the Secretary of State acting more as a backstop than a driver of change. This shift implies that, where local processes are sound, the risk of political intervention is significantly reduced.

3. Local Relationships, Especially with HOSCs, Are Crucial
The strength of the relationship with the local Health Overview and Scrutiny Committee can significantly affect a scheme’s trajectory. In Surrey, for instance, no scheme has ever been referred — a reflection of mature and trusting local dialogue. Conversely, more adversarial dynamics, as seen in Oxfordshire, can generate unnecessary tension. Early, transparent engagement with HOSCs isn’t just best practice — it’s a strategic necessity.

4. The Nature of the Change Still Matters
However robust the clinical rationale, some changes remain more politically and publicly sensitive than others — particularly closures, reductions in staffing, or significant increases in travel time to access care. Systems must not only ensure that their proposals are clinically credible but also that have a compelling and defensible narrative.

5. The Political Calendar Shapes Appetite for Change
The political climate presents both opportunity and risk. Ministers may be more inclined to support bold, reform-oriented decisions — but equally, the optics of service reductions in marginal constituencies remain politically sensitive. Systems must tread carefully: it is inconsistent to ask for public support while simultaneously advancing cuts without sufficient engagement.

Although the threshold for central intervention appears to have risen this doesn't warrant complacency, having a sound and credible case is still crucial. Get in touch with us to see how our expertise can support the recent developments in the NHS and specific reconfiguration proposals.

By Simon Angelides

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