Reconfigurations
Reconfiguration is the term used to describe the management of service change in the NHS that has an impact on patients. The scale of possible change is broad, ranging from the small-scale closure of a GP surgery to a more significant replacement of a number of stroke units with a centralised hyper acute stroke unit.
	Unless there is a need for urgent temporary reconfiguration of services, which is usually for reasons of patient safety, most service changes happen locally with consultation. Planned reconfigurations are developed at local or regional levels by commissioners. The Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013 imposes requirements on relevant persons to consult the local authority where a substantial development of the health service or substantial variation in the provision of health services is proposed. This regime is intended to continue so that the day to day interactions between NHS commissioners, NHS providers and local authorities do not change. Local NHS commissioners will continue to be accountable to NHS England for the discharge of their functions in these matters, including planning, consulting and delivering on service change proposals.
	The Secretary of State, pre-Act, was only able to intervene in reconfigurations upon receiving a local authority referral relating to the adequacy of consultation, or whether the proposal was in the interest of the health service. Following a referral, the Secretary of State had a discretionary power to take certain decisions based on the grounds of the referral. The Secretary of State typically asked the Independent Reconfiguration Panel (IRP) to provide expert advice and recommendations. The Secretary of State considered all of the available evidence, the expert advice of the IRP and the impacts of the proposal before making a decision on the matter, which could include giving a direction to NHS England. While this approach was able to help with difficult cases, referrals often came very late in the process meaning Ministers had to account for service changes in Parliament without having been meaningfully engaged on them themselves.
	The Act adds a new discretionary power to the NHS Act 2006 for the Secretary of State to call in and make a decision on a reconfiguration proposal. The Secretary of State will be able to use this call-in power at any stage of the reconfiguration process.
	This power is intended to be used in cases which are complex, a significant cause for public concern, or where Ministers can see a critical benefit to taking a particular course of action. Cases such as these can lead to difficult debate and lengthy processes.
	To support this intervention power, the Local Authority referral power, which is set out in regulations made under enabling powers in section 244 of the NHS Act 2006, will be amended to reflect the new process. There is no intention to remove the local Health Oversight and Scrutiny Committee (HOSC) role or the requirement to involve them in reconfigurations.
	Where a reconfiguration has been called in by the Secretary of State using the powers in the Act, there is a duty on NHS England, integrated care boards or NHS trusts and NHS foundation trusts to provide any information or assistance that the Secretary of State requires. This may include any representations that a HOSC, stakeholder, patient group or any other interested party have made, if applicable.
	NHS England, an integrated care board or an NHS trust or NHS foundation trust must provide all relevant information and take no further action in progressing the reconfiguration without the Secretary of State’s agreement. They will be able to make representations to the Secretary of State in support of their preferred option at this stage.
	The Secretary of State will seek appropriate advice in advance of their decision to meet the legal duties placed on them - including in relation to value for money, reducing inequalities, and continuous improvement in the quality of health services - and subsequently publish their decision in a transparent manner.
	The Secretary of State will publish guidance for NHS England, integrated care boards, NHS trusts and NHS foundation trusts about how they should be exercising their functions under this new process, as well as how the Secretary of State may exercise their functions during this new process. These NHS bodies must have regard to such guidance provided by the Secretary of State.
	It is intended that guidance will also provide detail for NHS bodies on exercising their duty to notify the Secretary of State of reconfigurations and clarify how the Secretary of State may use expert advice, including advice from the Independent Reconfiguration Panel.
	The Secretary of State will be able to exercise the call-in power at any stage of a reconfiguration process, and will also be able to be the catalyst for a reconfiguration where he or she thinks appropriate. This might occur before NHS England, integrated care boards, NHS trusts or NHS Foundation Trusts have notified the Secretary of State of a proposed reconfiguration but where the Secretary of State is aware of an emerging issue after stakeholders have raised the issue with the Secretary of State or information has been supplied from within DHSC.