The best configuration of hospital services for Wales : A review of the evidence. QUALITY AND SAFETY.

Over the life of the NHS, primary, community and hospital services have been subject to significant change and development. In the past 50 years, in line with international trends, the number of acute hospitals in the United Kingdom has reduced by 85%, and the number of sites at which elements of highly specialist care is delivered has reduced even further. These changes reflect developments in drug treatments, medical technology and clinical practice, as well as changes in professional and public expectations. We have grown used to a wider range of services being available through GPs and community staff, and as day surgery and complex investigations in hospitals.While change in the NHS is not new, there is increasing recognition that when the Welsh Government or Local Health Boards want to change the way services are organised and delivered, the case for change must be based on sound evidence, clearly articulated about the impact of change on outcomes for individual patients and communities.This paper provides a summary of the evidence currently available to inform the national and local discussions on the case for change in Wales. It has been developed on the basis that, where reconfiguration of services is proposed on the basis of safety and improving outcomes alone, the case for change should be able to answer the following question: How strong is the evidence that safety and outcomes will be improved by these changes?