This project focuses on the objectives and the process of hospital change. It looks at why and how hospitals should change. It is for local decision-makers to work out the details of local health service provision – the ‘what’ of the future hospital. At present, in part because of the political barriers to change, the NHS is not achieving the best outcomes from reconfiguration in terms of improving quality and access to services. Nor is it maintaining public trust and confidence in the process of change. This paper argues that this situation needs to be reversed if the NHS is going to succeed for future generations.