Healthcare professionals have little structure or set policy in place to help with decision making and implementation when decommissioning and replacing healthcare services, a study has found.
Researchers at the University of Birmingham found that a lack of policy and procedure led to higher levels of conflict, with outcomes harder to predict than for other areas of decision making, leading to confusion over roles and responsibilities.
It was also found that stakeholders affected by decommissioning were often sceptical about legitimacy of the withdrawal of services.
Of the 56 Clinical Commissioning Groups (CCG’s) questioned, 77% had decommissioning activities underway with the most common intended outcome to improve cost effectiveness, followed by patient experience and improved clinical effectiveness.
The most common type of decommissioning activity reported by CCG’s was relocation (28%) or replacement of a service as part of a reconfiguration of a service (25%) or closure of a service (14%).
It was also felt there was a lack of guidance from national bodies and a lack of staff skills necessary for decommissioning.
Dr Iestyn Williams, Health Services Management Centre, University of Birmingham, said: “A key problem for those leading decommissioning is convincing stakeholders of the legitimacy of their plans.
“For example, citizens, patient/service user representatives, carers, and local community groups spoke of a strong sense of loss around service withdrawal, and many felt that decommissioning decisions were made mainly for financial or political reasons rather than to improve patient experience.”
The study suggests that decommissioning is now being attempted to a degree that is unprecedented within the NHS, with one of the drivers being financial pressure.
But, the researchers found that decommissioning should be considered as the last step in a process after the case for change had been shared and argued widely.
The study highlighted a number of ways decommissioning could be successfully achieved and Dr Williams added: “Although no simple decommissioning formula exists, successful programmes typically address change management and implementation, evidence and information, and relationships and politics.”
The researchers made a number of recommendations for future best practice based on their case studies:
- draw on evidence, reviews and policies to frame the ‘problem’ which decommissioning is required to solve
- build alliances in order to legitimise decommissioning as a solution to this problem
- seek wider involvement, including of patients and community-based interest groups, and
- devise realistic implementation plans and timescales
- The University of Birmingham is ranked amongst the world’s top 100 institutions, its work brings people from across the world to Birmingham, including researchers and teachers and more than 5,000 international students from over 150 countries.
- A copy of Dr Williams’ research paper ‘Decommissioning health care: identifying best practice through primary and secondary research a prospective mixed-methods study’ can be downloaded here