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Doing More with Less in Health Care: Findings from a Multi-Method Study of Decommissioning in the English National Health Service

Published online by Cambridge University Press:  30 October 2017

JENNY HARLOCK ,
IESTYN WILLIAMS ,
GLENN ROBERT ,
KELLY HALL ,
RUSSELL MANNION  and
SALLY BREARLEY
JENNY HARLOCK
Affiliation:
Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF. email: jenny.harlock@dph.ox.ac.uk
IESTYN WILLIAMS
Affiliation:
Health Services Management Centre, University of Birmingham, Park House, 40 Edgbaston Park Road, Birmingham, B15 2RT. email: I.P.Williams@bham.ac.uk
GLENN ROBERT
Affiliation:
The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA. email: glenn.robert@kcl.ac.uk
KELLY HALL
Affiliation:
Department of Social Policy and Social Work, University of Birmingham, Muirhead Tower, Edgbaston, Birmingham, B15 2TT. email: k.j.hall@bham.ac.uk
RUSSELL MANNION
Affiliation:
Health Services Management Centre, University of Birmingham, Park House, 40 Edgbaston Park Road, Birmingham, B15 2RT. email: r.mannion@bham.ac.uk
SALLY BREARLEY
Affiliation:
The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA. email: s.brearley@icloud.com
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Abstract

In the context of an austere financial climate, local health care budget holders are increasingly expected to make and enact decisions to decommission (reduce or stop providing) services. However, little is currently known about the experiences of those seeking to decommission. This paper presents the first national study of decommissioning in the English National Health Service drawing on multiple methods, including: an interview-based review of the contemporary policy landscape of health care decommissioning; a national online survey of commissioners of health care services responsible for managing and enacting budget allocation decisions locally; and illustrative vignettes provided by those who have led decommissioning activities. Findings are presented and discussed in relation to four themes: national-local relationships; organisational capacity and resources for decommissioning; the extent and nature of decommissioning; and intended outcomes of decommissioning. Whilst it is unlikely that local commissioners will be able to ‘successfully’ implement decommissioning decisions unless aspects of engagement, local context and outcomes are addressed, it remains unclear what ‘success’ looks like in terms of a decommissioning process.

Type
Article
Information
Journal of Social Policy , Volume 47 , Issue 3 , July 2018 , pp. 543 - 564
Copyright
Copyright © Cambridge University Press 2017 

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