Types of Service Change

Our health and social care system needs to prepare for the future, by finding ways to support an evolving population that is ageing, with emerging new communities and an increasing prevalence of long-term conditions. Some of these will require difficult decisions to be made, and this process is known as a service review or reconfiguration.

Some examples of these include reviews and reconfigurations to local Urgent Care and Walk in Centres, Minor Injury Units and Hospitals.


As local populations, medicine, and health guidelines and learning from previous policies evolve, commissioners maintain a responsibility to ensure that local services remain relevant and tailored to the community it serves.

Across the country, certain health priorities are currently being reviewed and generating positive public input include the following:

  • End of Life and Palliative Care
  • Falls Prevention
  • Dementia
  • Mental Health – Child and Adolescent Mental Health Services (CAMHS)
  • Mental Health – Primary Care
  • Intermediate Care

If you are working on any of the above, and would like to know if anyone else might be too, please get in touch with our Navigators via email This email address is being protected from spambots. You need JavaScript enabled to view it. if you would like some support. Alternatively, you can also post on our online forum once logged in and ask the wider engagement community who are always ready with fantastic insights.

Service closure 

Services come to a close for a variety of reasons; sometimes as a result of review, and sometimes due to natural circumstances such as a contract or pilot initiative drawing to an end, or perhaps a retiring GP who has decided to close his/her surgery.

If and when a service closure happens, the commissioning organisation has a responsibility to identify similar alternative services to ensure that where possible, patients can continue to receive these services elsewhere.

Particular attention will need to be given to service users who are vulnerable and their carers, or fall under the 9 protected characteristics of the Equalities Act 2010.

Commissioning or re-commissioning a service

Health services are regularly monitored and reviewed to ensure they continue to provide the best possible care to patients. It also ensures that any concerns can be acted on promptly and improvements can be made at every opportunity.

Patient experience, clinical expertise, as well as local population insight can provide useful intelligence to ensure that services remain fit for purpose in an evolving society, adhere to national guidelines and are continually tailored to meet local needs.

Some examples of services currently being reviewed for commission / recommission include stroke, phlebotomy, and respiratory services.

Policy Harmonisation

Following the recent NHS reorganisation, emerging Clinical Commissioning Groups inherited policies for a variety of services from Primary Care Trusts. Due to new geographical areas covering parts of old PCTs, some CCGs found that they might inherit more than just one policy for a particular service.

In order to streamline services and minimise “postcode lottery”, CCGs work hard to harmonise policies to promote fairness and equitable access.  Assisted Conception is currently a key workstream for policy harmonisation; aside from promoting fairness and equity, it also provides an opportunity to extend access to include those who fall under the 9 Protected Characteristics of the Equalities Act 2010.

National initiatives

Better Care Fund / Intermediate Care

The August 2013 Spending Review established the £3.8 billion BCF "to deliver better outcomes and greater efficiencies through more integrated services for older and disabled people." - find out more about the Better Care Fund/Intermediate Care.

Continuing Healthcare

NHS Continuing Healthcare is the name given to a package of care that is arranged and funded solely by the NHS for individuals who are not in hospital but have complex ongoing healthcare needs.

NHS Continuing Healthcare is a package of care (health, personal care and accommodation costs) arranged and funded solely by the NHS .Anyone assessed as having a certain level of care needs may receive NHS Continuing Healthcare. It is not dependent on a particular disease, diagnosis or condition, nor on who provides the care or where that care is provided.

In October 2007, the Department of Health produced the NHS Continuing Healthcare Framework. The framework, which was revised in 2009, sets out a single national system for determining eligibility for NHS Continuing Healthcare irrespective of location, diagnosis or personal circumstances.

Currently, around 53,000 people in England are in receipt of NHS Continuing Healthcare. Read more information on NHS Continuing Healthcare.

Personal Health Budgets

A personal health budget is an amount of money that is allocated to an individual to allow them to meet their health and wellbeing needs in a way that best suits them. At the heart of a personal health budget is a care plan. This sets out the individual’s health (and social care) needs and includes the desired outcomes, the amount of money in the budget and how this will be spent. The care plan is agreed between the individual and the professional, before being checked and signed off by the NHS.


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