Impact and risk assessments should be made public, and debated publicly, before a proposal for any major structural change to the healthcare system is accepted. Such assessments should cover at least the following issues:
- What is the precise issue or concern in respect of which change is necessary?
- Can the policy objective identified be achieved by modifications within the existing structure?
- How are the successful aspects of the existing system to be incorporated and continued in the new system?
- How are the existing skills which are relevant to the new system to be transferred to it?
- How is the existing corporate and individual knowledge base to be preserved, transferred and exploited?
- How is flexibility to meet new circumstances and to respond to experience built into the new system to avoid the need for further structural change?
- How are necessary functions to be performed effectively during any transitional period?
- What are the respective risks and benefits to service users and the public and, in particular, are there any risks to safety or welfare?
It is good practice for all major changes of policy and of system structure to be carefully considered and taken forward on the basis of a clearly defined purpose and with a clear and detailed implementation plan – taking into account the major risks to the safety or welfare of patients, and to the effective operation of the system. When the policy or change of system structure is completed, or has advanced to a predetermined degree, it should undergo a comprehensive evaluation.