What drives successful (and sustainable) system change? This won't stop being a relevant and compelling question. We should perhaps acknowledge though that, at least in terms of healthcare, we have a prevailing orthodoxy - that top down, mandated and performance managed changed is the default method.

The healthcare system has been trained to receive and act upon the annual operating plan. That plan describes the what, the how, the 'by when', and the 'how much'.

We at the Stroke Association are boldly pro-reconfiguration. As an organisation representing over a million stroke survivors and advocating for the best possible treatment and care, how could we be anything else?
 
We see it as our duty to ensure as many patients as possible get access to world-class treatments and round-the-clock care – both of which are more likely in reconfigured acute stroke services.

Evidence of the benefits of stroke service reconfiguration is overwhelming. Where it has already happened, for example in London and Greater Manchester, reconfiguration is saving hundreds of lives a year, and patients are reporting positive experiences of care in hyper-acute stroke units (HASUs).