The NHS is undergoing a profound process of transformational change. At its heart is the vision of a service focused around the patient, delivering against national standards and showing clear improvements in the quality of care provided.

At the same time the NHS must adapt to a rapidly changing environment, grasping the opportunities offered by technological and medical advance and managing pressures, particularly on the workforce.

In this environment many local health communities will be stimulated to think about how they could improve the system design and consequential configuration of services ensuring the best possible patient experience.

System reconfiguration

In the past this has been largely reactive, with change driven by external factors. Over the years it has become synonymous for many local communities with the loss of services, especially highly valued 24 hour emergency services, through closure and centralisation. In some places the process has generated significant tensions between local health services and the communities they serve.

System change now needs to become proactive: a positive reshaping of local services designed to deliver new models of care. In this context, sustaining and improving local access to services must be at the heart of the quality debate. The public will in future have a pivotal role as partners with the NHS in driving innovation and planning the future shape of services which needs to encompass the whole system including:

• hospital based services
• services outside hospital
• social care services
• non NHS provided services

Innovative thinking

• There are many examples of innovative thinking around the NHS which typify a new integrated whole system approach. These are characterised by
• services designed with local populations, not for them
• solutions developed for health communities rather than for individual hospitals or organisations - managing care across traditional boundaries
• use of service improvement strategies, especially changing working patterns

It is particularly important to find sustainable solutions for smaller hospitals that are particularly challenged by pressures and changes in the environment. The encouraging news is that redesign offers real alternatives to relocating services and extends the range of options for developing new configurations which meet local needs and expectations.

See Information Exchange Issue 48 for The Academy of Medical Royal College report giving its recommendations for the reconfiguration of acute care services in England.

Strategic Health Asset Planning and Evaluation toolkit (SHAPE) has been developed by the Department of Health. SHAPE is a web enabled, evidence based tool designed to support and inform strategic planning for organisations delivering service reconfiguration. See Information Exchange Issue 46 for information.

FHN and the NHS Confederation also look at international developments, encouraging learning across borders and linking with organisations around the world. For more details please see the NHS Confederation's International Work Programme.