Clinical Commissioning Groups (CCGs) in England must engage with the public, clinicians, and politicians as early as possible when taking potentially controversial decisions such as closing local services, new guidance has advised. Commissioners should also ensure that “tough decisions” about funding, prioritisation, and possible closures are safe, cost effective, and backed by robust evidence, the report from NHS Clinical Commissioners, the membership body for CCGs, said.1 The group said it had issued the guidance as local health bodies in England were going through a period of major change that made hard choices “increasingly inevitable.” It said that ongoing financial pressures and the development of 44 System and Transformation …