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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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References

Abbott, S., Procter, S. and Iacovou, N. (2009),‘NHS purchaser/provider relationships in England and Wales: the view from primary care’, Social Policy and Administration, 43 (1), 1–14.CrossRefGoogle Scholar
Alderwick, H., Dunn, P., McKenna, H., Walsh, N. and Ham, C. (2016), Sustainability and transformation plans in the NHS, How are they being developed in practice? London: Kings FundGoogle Scholar
Bate, A., Donaldson, C. and Murtagh, M. J. (2007), ‘Managing to manage healthcare resources in the English NHS? What can health economics teach? What can health economics learn?’ Health Policy, 84 (2–3), 249–61.CrossRefGoogle ScholarPubMed
Lord Carter of Coles (2016), Operational productivity and performance in English NHS acute hospitals: Unwarranted variations, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/499229/Operational_productivity_A.pdf (accessed 20/04/2017)Google Scholar
Checkland, K., Coleman, A., Harrison, S. and Hiroeh, U. (2009), “‘We can't get anything done because. . .’: making sense of ‘barriers’ to Practice-based Commissioning” Journal of Health Services Research and Policy, 14 (1), 20–26.Google Scholar
Checkland, K., Harrison, S., Snow, S., McDermott, I. and Coleman, A. (2012), “Commissioning in the English National Health Service: What's the Problem?” Journal of Social Policy, 41 (3), 533–550Google Scholar
Checkland, K., McDermott, I., Coleman, A. and Perkins, N. (2015), “Complexity in the new NHS: longitudinal case studies of CCGs in England” British Medical Journal doi:10.1136/bmjopen-2015-010199Google Scholar
Creswell, J. W. and Clark, V. L. P. (2011), Designing and conducting mixed methods research, London: Sage.Google Scholar
Daniels, T., Williams, I., Robinson, S. and Spence, K. (2013), “Tackling disinvestment in health care services: the views of resource allocators in the English NHS” Journal of health organization and management; 28–27 (6), 762–80.Google Scholar
Department of Health (2010), Equity and Excellence: Liberating the NHS, London: The Stationary Office.Google Scholar
Edwards, N. (2016), ‘What do we know about STPs so far?’. Nuffield Trust comment, 25 November 2016. https://www.nuffieldtrust.org.uk/news-item/what-do-we-know-about-stps-so-far (accessed 20/04/17)Google Scholar
Greenhalgh, T., Howick, J. and Maskrey, N. (2014), “Evidence based medicine: a movement in crisis?” British Medical Journal 348, g3725.Google Scholar
Committee, Health Select (2010), Commissioning, House of Commons Health Committee 4th Report of Session 2009–2010, London: The Stationery Office.Google Scholar
Health Select Committee (2011), Commissioning: Further Issues, London: The Stationery Office.Google Scholar
HM Treasury (2016), Autumn Statement 2016 https://www.gov.uk/government/publications/autumn-statement-2016-documents (accessed 20/04/2017)Google Scholar
HM Treasury (2017), Spring Budget 2017 https://www.gov.uk/government/publications/spring-budget-2017-documents (accessed 20/04/2017)Google Scholar
Hurley, R. (2014), “Can doctors reduce harmful medical overuse worldwide?” British Medical Journal, 349, d4289.CrossRefGoogle ScholarPubMed
Johnstone, P.L. (2004), “Mixed Methods, Mixed Methodology Health Services Research in Practice” Qualitative Health Research, 14 (2), 259–271.CrossRefGoogle ScholarPubMed
Klein, R. (2013), The New Politics of the NHS, (Seventh edition), London: Radcliffe Publishing.Google Scholar
Lafond, S., Charlesworth, A. and Roberts, A. (2016), A perfect storm: an impossible climate for NHS providers’ finances? An analysis of NHS finances and factors associated with financial performance http://www.health.org.uk/publication/perfect-storm-impossible-climate-nhs-providers%E2%80%99-finances (accessed 20/04/2017)Google Scholar
Malhotra, A., Maughan, D., Ansell, J., Lehman, R., Henderson, A., Gray, M., Stephenson, T. and Bailey, S. (2015), “Choosing Wisely in the UK: the Academy of Medical Royal Colleges’ initiative to reduce the harms of too much medicine”, British Medical Journal; 350, h2308Google Scholar
McCafferty, S., Williams, I., Hunter, D., Robinson, S., Donaldson, C. and Bate, A. (2012), “Implementing world class commissioning competencies”, Journal of Health Services Research and Policy, 17 (1), 40–48.Google Scholar
McDermott, I., Checkland, K., Coleman, A., Osipovič, D., Petsoulas, C. and Perkins, N. (2017), “Engaging GPs in commissioning: realist evaluation of the early experiences of Clinical Commissioning Groups in the English NHS”, Journal of health services research & policy, 22 (1), 4–11.CrossRefGoogle ScholarPubMed
Monitor (2013), Closing the NHS funding gap: how to get better value healthcare for patients, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/284044/ClosingTheGap091013.pdf (accessed 20/04/2017)Google Scholar
NHS Confederation (2014), “Health service is driving change but needs support, survey finds”, http://www.nhsconfed.org/news/2014/03/health-service-is-driving-change-but-needs-support-survey-finds (accessed 20/04/2017)Google Scholar
NHS England (2014), Five Year Forward View http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf (accessed 20/04/2017)Google Scholar
Pierson, P. (1994), Dismantling the welfare state? Reagan, Thatcher, and the Politics of Retrenchment, Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Robert, G., Harlock, J. and Williams, I. (2014), “Disentangling rhetoric and reality: an international Delphi study of factors and processes that facilitate the successful implementation of decisions to decommission healthcare services”, Implementation Science, 9 (1), 123 https://doi.org/10.1186/s13012-014-0123-y.CrossRefGoogle ScholarPubMed
Robinson, S., Williams, I., Dickinson, H., Freeman, T. and Rumbold, B. (2012), “Priority-setting and rationing in healthcare: evidence from the English experience”, Social Science & Medicine, 75 (12), 2386–2393.CrossRefGoogle ScholarPubMed
Robinson, S., Glasby, J. and Allen, K. (2013), “‘It ain't what you do it's the way that you do it’: lessons for health care from decommissioning of older people's services”, Health & social care in the community, 21 (6), 614–622.Google Scholar
Sampson, F., O'Cathain, A., Strong, M., Pickin, M. and Esmonde, L. (2012), “Commissioning processes in primary care trusts: a repeated cross-sectional survey of health care commissioners in England”, Journal of Health Services Research and Policy, 17 (1), 31–39.CrossRefGoogle ScholarPubMed
Smith, J., Porter, A., Shaw, S., Rosen, R., Blunt, I. and Mays, N. (2013), Commissioning high quality care for people with long-term conditions, London: Nuffield Trust.Google Scholar
Wenzl, M., McCuskee, S. and Mossialos, E. (2015), “Commissioning for equity in the NHS: rhetoric and practice”, British medical bulletin, 115 (1), 5–17.CrossRefGoogle ScholarPubMed
Williams, I., Harlock, J., Robert, G., Mannion, R., Brearley, S. and Hall, K. (2017), Decommissioning health care: identifying best practice through primary and secondary research. National Institute for Health Research.Google Scholar