Health Services and Delivery Research 2017;5(22) https://dx.doi.org/10.3310/hsdr05220
- This study examines the evidence base on which to guide policy and practice in decommissioning through expert opinion, a survey and interviews with CCGs and discussions with patient/service users.
- The study concludes that there is a lack of robust evidence to guide decommissioning, but among experts there is a high level of consensus for the following good-practice principles: establish a strong leadership team, engage clinical leaders from an early stage and establish a clear rationale for change.
- The most common type of CCG decommissioning activity was ‘relocation or replacement of a service from an acute to a community setting’ (28% of all activities) and the majority of responding CCGs (77%) were planning to decommission services.
- Case studies demonstrate the need to (1) draw on evidence, reviews and policies to frame the problem; (2) build alliances in order to legitimise decommissioning as a solution; (3) seek wider acceptance, including among patients and community groups, of decommissioning; and (4) devise implementation plans that recognise the additional challenges of removal and replacement.
- Case studies include
- Decommissioning as part of the national reorganisation of paediatric burn care services in England
- Local decommissioning of an end-of-life home support service
- Decommissioning in the work of an Area Prescribing Committee
- Reorganisation of local primary and acute care services, involving decommissioning of a local hospital and centralisation of acute services at alternative sites
- Citizens, patient/service user representatives, carers, third-sector organisations and local community groups were more likely to believe that decommissioning is driven by financial and political concerns than by considerations of service quality and efficiency, and to distrust and/or resent decision-makers. Overall, the study suggests that failure rates in decommissioning are likely to be higher than in other forms of service change, suggesting the need for tailored design and implementation approaches.
- Definition: Decommissioning – defined as the planned process of removing, reducing or replacing health-care services.
