Title: Decommissioning health care: identifying best practice through primary and secondary research
Funder: Department of Health (England)

Abstract: 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.Research questionsThe overall aim of the research is to formulate evidence-informed best practice guidance to enable the effective decommissioning of NHS services. To this end the project will address three key research questions:Q1. What is the international evidence and expert opinion regarding best practice in decommissioning health care services?Q2. How and to what extent are NHS organisations currently decommissioning services?Q3. What factors and processes facilitate the successful implementation of decisions to decommission NHS services? Research design and data collectionIn order to address each of these questions the research is organised around three distinct but inter-connecting work-packages:Work-package one will synthesise what is already known about implementing decommissioning in health care and other public sector settings (Q1). 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 (Q2). 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 (Q3). These will be mixed-method and in-depth and a comparative cross-case 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.Data analysis and outputsThese 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.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE