NHS managers have been told that reconfiguring secondary care in the UK must go ahead, and both politicians and staff needed to get on board to make tough decisions.

Speaking at this week’s NHS Confederation conference in Liverpool Mike Farrar, the body’s chief executive, said: “More than two-thirds of NHS Confederation members have told us ‘political resistance’ is the biggest barrier they face in relation to successful service reconfiguration.

“But political courage by itself is not enough to deliver the kind of change that the NHS needs at this point in its life; the service itself must overcome its paralysis in relation to change, and it must bring the right people with it.”

He went on: “The onus is on us in the NHS to build the case for change amongst the people we need support from, so that ‘reconfiguration’ stops being a dirty word and starts to represent the kind of planned, well-evidenced change programme which the NHS deserves.”

For a number of years both the NHS Confederation and the influential health think-tank The King’s Fund have argued that a number of hospitals should be shut down and replaced with community care.

The system of having large buildings capable of supporting a whole host of problems and emergencies is becoming out-dated, they argue, and want to see more specialist centres bespoke for communities.

Hospitals are also a major drain on NHS finances, with A&E departments taking tens of billions of pounds from the budget’s purse each year – if more viable ways of dealing with accidents and emergencies was found – like the ill-fated 111 system – this could also help to save money in the long-term.

But patients remain skeptical of the need for these closures and changes in hospital care, and has become a political hot potato over the past ten years.

A new report, also published at the conference this week by the NHS Confederation, is calling for “meaningful engagement” of the public, patients, politicians and health professionals in proactive, well-planned service changes, and highlights the highly influential role for clinicians in communicating a clear case for change.

It sets out a number of recommendations each for local health service leaders and their national counterparts to ensure essential reconfigurations – underpinned by sound clinical reasons – can proceed with the understanding and support of relevant stakeholders.

Jeremy Taylor, chief executive of National Voices, says: “Patients are not best served by the current pattern of services. For the safest, highest quality care, hospitals need to be organised differently and more services are needed closer to people’s homes. But the changes needed are often highly controversial.

“The NHS has often failed to make a good case; to involve patients and communities in ways that would build trust and to follow through to ensure that the new pattern of services is better than the old. And the public are rightly suspicious of closures and downgrades that seem to be more to do with money than quality of care. It is hardly surprising that local politicians often rush to defend the status quo – even if it is not the longer term interests of patients.”

Political U-turn

One such politician “rushing to defend the status quo” has been the health secretary Jeremy Hunt, who endorsed a candlelight vigil from his Guildford constituents to save the Royal Surrey County Hospital’s A&E department from closure in 2006/07.

He continued to say he would defend hospitals from closure after becoming health secretary last year, but yesterday took a different tune.

Responding to the Confederation’s report, Hunt said that service changes, including reducing the number of hospitals dealing with particular conditions, “can mean risk associated with those conditions is reduced”, implying the government may be closer to accepting the need for reconfiguration.