Decommissioning health care: identifying best practice

Making the most of NHS resources requires investment in new services as well as stopping services that do not give the best benefits to patients. However, reducing, replacing or removing health care, known as decommissioning, is difficult to achieve and the evidence base on which to guide policy in this area is weak. This project aims to provide evidence-based advice on this topic.

As well as finding ways to introduce new treatments and services, health systems need to replace and remove interventions and services as they become outdated. However, this has proven challenging, especially when major changes to current practices are involved. 

The aim of this study was to identify the factors that influence the decommissioning of health services.  It involved an expert panel, a national survey of commissioners, case studies of decommissioning processes, and research with patients, citizens and others affected by decommissioning.  The end result of these data collection activities is some tentative conclusions and recommendations regarding ‘best practice’ in this area. These cover issues such as the role of evidence, the influence of politics, the priorities and expectations of users and communities and the skills required of those leading decommissioning. 
Researcher Iestyn Williams offers some insights into the Decommissioning project

Researcher Iestyn Williams offers some insights into the Decommissioning project.

Dates

May 2013  - present

Researchers

Dr Iestyn Williams, Health Services Management Centre, University of Birmingham
Professor Russell Mannion, Health Services Management Centre, University of Birmingham
Dr Kelly Hall, Department of Social Policy, Sociology and Criminology, University of Birmingham
Jenny Harlock, University of Oxford
Glenn Robert, Kings College London
Sally Brearley, Kingston University

Outputs

The most common type of decommissioning activity reported by Clinical Commissioning Groups was relocation (28%) , replacement of a service as part of a reconfiguration of a service (25%) or closure of a service (14%). Some of our case studies made progress with their plans, whereas others did not and found this frustrating. There was felt to be a lack of guidance from national bodies, and also a lack of the staff skills necessary for decommissioning.

Citizens, patient/service user representatives, carers, third-sector organisations and local community groups spoke of a strong sense of loss around losing services, and many felt that decommissioning decisions were made mainly for financial or political reasons rather than to improve patient experience. Our study identifies important insights for the range of groups affected by decommissioning in health care. Good-practice principles for leading decommissioning processes and engaging service users and citizens are provided; however, the study suggests that no simple formula exists for doing decommissioning well.

Decommissioning is often a long-term pursuit and has a greater chance of implementation when based on an understanding of local context and relationships of trust. Ambitious plans in particularly require careful programme design and a range of forms of involvement. Additional good practice principles include:

  1. Engage and involve clinical leaders from an early stage.
  2. Establish a clear rationale and narrative for change.
  3. Ensure clear and thorough project planning and governance.
  4. Secure high-level political support (national and local) at an early stage.
  5. Base decisions on evidence of what works.
  6. Adopt a whole-systems perspective from the beginning