Fears over hospital merger plans
An ex-senior civil servant is warning that a new government policy forcing a rethink on hospital reorganisations in England could cost money.
Plans to close or downgrade some hospitals in England are facing hold-ups after a review ordered by health secretary Andrew Lansley.
Mark Britnell oversaw services moving to fewer hospitals in Birmingham.
He believes many of the original plans will go ahead but with delays of up to a year.
Mr Britnell held a top job at the Department of Health before moving to the professional service provider KPMG last year. He said: "Elapsed time costs money. My real fear is that, whilst we're still talking about making these clinical changes, we're wasting the opportunity to produce quicker clinical benefits for patients.
"It's a pretty big job to get clinical change bedded into the NHS. My understanding is that many of these plans are good to go.
"Many of the changes developed over the last two years weren't developed to save money - they were designed to improve the quality of care."
The review - announced two months ago - told NHS managers to make sure their plans were supported by local GPs and the public, as well as being underpinned with "greater clarity about the clinical evidence base".
Further details, which were due to have been released last month, have not yet emerged.
Mr Britnell said: "There was a sense of disappointment when the announcement was made - particularly in London and the North West of England, where clinicians feel they have been making good progress.
"Since then, people have regrouped. I don't think any permanent damage has been done to sensible reconfiguration proposals."
During the election campaign, Mr Lansley promised an end to "top-down" reconfigurations.
Moves to downgrade or close local hospitals have often attracted fierce protests and many local campaigners have welcomed the new policy.
But leaders at NHS London, which was planning a big reorganisation, have reacted furiously with the chairman and some board members resigning.
Risk of collapse
Proposals to close a maternity unit in Bury have also been put on hold. This was part of a much bigger plan to reorganise maternity and children's services across Manchester, with a new unit being built in the north of the city.
An NHS source said: "This is a big jigsaw. If Bury doesn't close, the whole lot is at risk of collapsing.
"Reducing the maternity units across Manchester was planned because without doing that, it's a question of whether there's enough expertise to provide safe maternity care in all hospitals."
Decisions to close a casualty unit in Burnley, which has already happened, and to move children's services from there to Blackburn will also be reviewed.
However, plans to concentrate services for stroke patients in a smaller number of specialist hospitals in London are going ahead this week. The idea is to give people the best quality care in the first 72 hours after a stroke.
The Stroke Association's communications director, Joe Korner, said: "I'm very relieved that these changes in stroke care have got in under the wire.
"There's no doubt that they will deliver improved care. The evidence is very convincing.
"Until now, London has had some of the best stroke care in the world - but also a lot of services which weren't up to the mark. The care you got was really a matter of luck, as to where in London you had your stroke.
"Sometimes government edicts can have unintended consequences. Had this change been halted, I'd have been very disappointed."
A Department of Health spokesperson said: "Where reconfiguration works well, what we see is that patient outcomes and choice, support from GPs and local health services and the public have been right at the heart of the process from the beginning.
"The Department wants to see an end to the kind of top-down changes to services that don't have local support and aren't motivated by the needs of patients.
"It is only right that NHS Trusts take time to assess whether any reconfiguration plans they have are properly thought through."