Reading List – Hospital reconfiguration

CHPI | April 8, 2013 | Resources

For some years, we have seen the development of a twin process of service reorganisation or reconfiguration: one process entails closing big hospital departments such as Accident and Emergency and Maternity Services so that these are concentrated in fewer, larger hospitals; the second involves transferring services from hospitals into community settings. These reorganisations can be, sometimes rightly, perceived by local people as service closures or downgrades and attract fierce opposition. The current round of cuts and ‘efficiencies’ has, if anything, increased the pressure for reconfiguration. The list here includes sources relevant to the process of reorganisation, research evidence on aspects of service organisation, case studies and broad overviews of service configuration.


1. The Academy Of MedicalRoyalColleges, Healthcare Financial Management Association And The NHS Confederation (2010) Improving Quality and Productivity In the NHS whilst Facing The Financial Pressures. Joint report.

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Includes a discussion of reconfiguration in relation to financial pressure in the NHS.

2. Academy of Medical Royal Colleges, Acute health care services – Report of a Working Party, Academy of Medical Royal Colleges, 2007.

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This report explores the options for the organisation of acute health care. It notes the absence of evidence about outcomes for much acute health care. Among other things, it concludes that Most district hospitals should continue to provide a full emergency service but with better integration with out-of-hours services, walk-in centre services and minor injury care.

3. Ahgren B (2008) Is it better to be big? The reconfiguration of 21st century hospitals: responses to a hospital merger in Sweden. Health Policy, Vol.87, No.1 (92-99).

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4. Boyle, S. and Steer, R. (2008) ‘The sham of NHS consultation on service provision’, Radical Statistics, Issue 96.

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5. Byrne, D. and Ruane, S. (2007) The Case for Hospital Reconfiguration – not Proven: A Response to the IPPR’s The Future Hospital. Keep Our NHS Public.

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This response to an Institute of Public Policy Report on hospital reconfiguration argues that evidence does not exist for a general relationship between volume of procedures and outcomes and that the policy significance of research findings is confounded by methodological weaknesses in the research.

6. Byrne, D. and Yang, K. (2008) ‘Conceptual and Statistical Problems in Exploring the Relationship among Volume, Outcome and Context in Relation to the Organization of Secondary and Tertiary Health Provision – an issue of causal inference in non-experimental research’, Radical Statistics, Issue 96.

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This paper addresses the way in which evidence about the health outcomes has been interpreted and the way in which those interpretations have been deployed in relation to the restructuring of central elements of health provision in localities in England.

7. The Centre for Public Scrutiny (July 2007) 10 questions to ask if you’re scrutinising NHS service redesign or reconfiguration. The Centre for Public Scrutiny.

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8. Chowdhury M., Dagash, H. and Pierro, A. (2007) A systematic review of the impact of volume of surgery and specialization on patient outcome. British Journal of Surgery, Vol.94, No.2 (145-161)

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9. College of Emergency Medicine(2012) Reconfiguration of Emergency Care system services, CEM Position statement,College ofEmergency Medicine

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This statement sets out the ten principles which the College of Emergency Medicine believes should underpin the configuration of emergency services.

10. Gaynor, M., Laudicella, M. and Propper, C. (2011) Can governments do it better? Merger mania and hospital outcomes in the English NHS. National Bureau of Economic Research. Working Paper No. 17608

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The literature on mergers between private hospitals suggests that such mergers often produce little benefit. Despite this, theUKgovernment has pursued an active policy of hospital merger.

11. Halm, E., Lee, C. and Chassin, M. (2002) ‘Is Volume Related to Outcome in Health Care? A Systematic Review and Methodological Critique of the Literature’ Annals of Internal Medicine, 137 511-520

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12. Hannan, E. (1999) ‘The relation between volume and outcome in health care’, New England Journal of Medicine, 340: 1677-1679

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Scores of articles pertaining to the relation between volume and outcome have been published, and studies continue to appear. This article considers how the results of these studies should be incorporated into policies aimed at improving the quality of health care.

13. Harrison, A. (2012) Assessing the relationship between volume and outcome in hospital services: implications for service centralization, Health Services Management Research, Vol 25, No. 1 pp1-6

Proposals for centralizing services are often justified on the basis of studies linking the volume of activity to the outcomes achieved. However, the evidence of such studies is far from demonstrating a causal link between volume and outcome. This article assesses the main reasons why volume and outcome studies do not in themselves demonstrate a causal link, and therefore do not provide adequate support for proposals for centralizing hospital services. It then sets out a number of precepts to guide those responsible for proposing centralization of services

14. Independent Reconfiguration Panel (2010) Learning from reviews: an overview (3rd edition). Independent Reconfiguration Panel.

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In this paper, the Independent Reconfiguration Panel sets out some themes – clinical, managerial and procedural – which have been identified from 17 reviews. They emerged in response to two questions: first, are there particular problems in healthcare delivery that have been common to these referrals? and, second, are there any other common factors in cases where proposals for change have been referred to the Secretary of State? In addressing these questions, the Panel has drawn on its own published reports, on a range of NHS guidance material, and on interviews with people who contributed to reviews as NHS leaders, local councillors or community representatives.

15. Kjekshus, L. and Hagen, T. (2007) Do hospital mergers increase hospital efficiency? Evidence from a National Health Service country. Journal of Health Services Research and Policy, Vol.12, No.4 (230-235)

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16. NPCRDC (2007) Evaluation of ‘Closer to Home’ Demonstration Sites: Final Report. National Primary Care Research and Development Centre

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An evaluation of services in six specialties transferred out of hospitals to community-based practitioners.

17. Nicholl, J., West, J., Goodacre, S. and Turner. (2007) The relationship between distance to hospital and patient mortality in emergencies: an observational study, Emergency Medical Journal, 24: pps 665-668.

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Reconfiguration of emergency services could lead to patients with life-threatening conditions travelling longer distances to hospital.

18. NHS London, Guidance on Reconfiguration, 2011, NHS London.

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This is the latest guide for NHS organisations on reconfiguration in Londonand sets out the official NHS London position.

19. Oborn, E. (2008) Legitimacy of hospital reconfiguration: the controversial downsizing of Kidderminster hospital. Journal of Health Services Research & Policy, Vol.13, Supplement 2 (11-18)

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This paper examines the contested organizational legitimacy of hospital reconfiguration, which continues to be a central issue in health care management.

20. Palmer, K. (2011) Reconfiguring Hospital Services: Lessons from SouthEast London.London: King’s Fund

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The paper considers whether reconfiguration of services across hospitals sites is an appropriate response to the need to drive up quality and drive down costs in the NHS in England.

21. Posnett, J. (2002) Are bigger hospitals better?, in M. McKee and J. Healy (eds) (2002) Hospitals in a Changing Europe. European Observatory on Health Care Systems series.  Open University Press

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Argues on the basis of existing evidence against a presumption that bigger hospitals are better and that the benefits of a particular merger or rationalisation need to be demonstrated by those proposing the merger or rationalisation.

22. Spurgeon, P. et al (2010) Evaluating models of service delivery: reconfiguration principles. NHS Service Delivery and Organisation (SDO) Programme.

This reports on research which set out to analyse and explain the process of reconfiguration, to evaluate its consequences within the limitations of both the data and of the possibilities of attributing events to causal processes originating with reconfiguration, and to draw any conclusions that might be of wider interest.

23. Pollock, A, Kondilis, E and Price, D with Kirkwood, G and Harding-Edgar, L (2013): Blaming the victims:the trust special administrator’s plans for southeast London.’

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