Decommissioning health care: identifying best practice through primary and secondary research

Although decommissioning - defined here as the planned process of removing, reducing or replacing health care services – is at the forefront of NHS policy it remains strikingly under-researched.

This project is designed to address this important knowledge-practice gap. The overall aim of the research is to formulate evidence-informed best practice guidance to enable the effective decommissioning of NHS services.

Work-package one will synthesise what is already known about implementing decommissioning in health care and other public sector settings. It combines a narrative synthesis of recent reviews of the literature and empirical evidence with the views of an international expert-panel via a Delphi exercise. Additionally, in order to develop a detailed understanding of the NHS decommissioning context, approximately 20 semi-structured, telephone interviews will be conducted with key informants from a range of health and social care agencies. In addition, five leaders of recent decommissioning projects in the NHS will be interviewed about their experiences and their views on implementing decommissioning policies.

Work-package two will establish the current range and extent of decommissioning in the NHS from the perspective of local commissioners. The online survey tool will collect both quantitative and qualitative data via a national questionnaire.

Work-package three will develop our understanding of how NHS organisations are currently implementing decommissioning policies through a prospective, longitudinal investigation of four case studies in the English NHS. These will be mixed-method and in-depth and a comparative crosscase analysis will enable us to draws lessons and facilitate learning with regard to the factors and processes that influence successful implementation and outcomes (e.g. in terms of service quality and efficiency) of decommissioning.

These multiple data sources will provide a rich and broad understanding of decommissioning and enhance both the validity and transferability of the results. Through application of a theoretical framework drawing on the political and organisational science literatures and actor-network theory we will develop new insights into the topic as well as aiding the formulation and implementation of NHS policy and practice. There is a strong international strand to the research and robust mechanisms for respondent validation and service user involvement. Through active and varied dissemination activities we will make substantive contributions to policy and practice in the NHS.

A further funded work-package has been added to the project in order to specifically explore decommissioning from the perspective of patients, service users, carers and the public.  This work-package involves qualitative focus group discussions with these groups in order to understand the language, experiences and meanings they bring to bear on the topic.  This will be used to inform a second Delphi-panel survey to enable comparison with the results from work-package one.

Date

1 May 2013 - 31 August 2016

Outputs

Outputs and activities will include:

• A plain language executive summary
• A short document detailing the key findings and implications for local NHS commissioners and managers in England.
• A final report to HS & DR specifications, suitable for peer review.
• Research papers in practitioner and academic journals.
• Presentations to key stakeholder audiences and conferences (including EURAM, NHS Confederation, OBHC).
• Individual feedback to the case study sites on the key findings and implications for decommissioning within their areas.
• Feedback events with service-users and patients.

Funder

National Institute for Health Research, HSDR programme.

Researchers(s)

University of Birmingham: Iestyn Williams, Russell Mannion, Kelly Hall, Jenny Harlock

Other: Glenn Robert, Sally Brearley