Is the end in sight? A study of how and why services are decommissioned in the English National Health Service

Iestyn Williams, Jenny Harlock, Glenn Robert, John Kimberly, Russell Mannion

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The decommissioning of a health care service is invariably a highly
complex and contentious process which faces many implementation
challenges. There has been little specific theorisation of this phenomena,
although insights can be transferred from wider literatures on policy
implementation and change processes. In this paper, we present
findings from empirical case studies of three decommissioning processes
initiated in the English National Health Service. We apply Levine’s (1979)
typology of decommissioning drivers and insights from the empirical
literature on pluralistic health care contexts, complex change processes,
and institutional constraints. Data include interviews, non-participant
observation and documents analysis. Alongside familiar patterns of
pluralism and political partisanship, our results suggest the important
role played by institutional factors in determining the outcome of
decommissioning processes, and in particular the prior requirement of
political vulnerability for services to be successfully closed. Factors linked
to the extent of such vulnerability include the scale of the proposed
changes and extent to which they are supported at the macro level.
Original languageEnglish
Pages (from-to)441-458
Number of pages18
JournalSociology of Health and Illness
Issue number2
Publication statusPublished - 26 Feb 2021

Bibliographical note

Funding Information:
Case study three involved the planned decommissioning of a charity end of life (EOL) home support service which provided non‐clinical support to patients, their families and carers. The service comprised a named nurse co‐ordinator who provided regular contact and home visits, alongside telephone access to a ‘care bureau’ providing triaging and 24‐h nursing advice and support. The service aimed to increase the percentage of patients dying in their preferred place of death, improve support for carers, and reduce unnecessary admissions to hospital. It had been funded by the NHS since 2009 with the contract due to expire at the time of fieldwork. In October 2013, a six‐month contract extension for existing patients was agreed to enable a review of the service, and this was followed by a three‐month managed closure process beginning in April 2014. This was the only one of the three decommissioning case studies to proceed to full implementation during the lifetime of the research project and therefore something of a ‘positive outlier’ both within the sample and the wider literature (Flyvbjerg, 2006 ) (Box 4 ).

Publisher Copyright:
© 2021 Foundation for the Sociology of Health & Illness.


  • case studies
  • disinvestment
  • health policy
  • health system change
  • health-care decommissioning
  • health-care reorganisation

ASJC Scopus subject areas

  • Health(social science)
  • Health Policy
  • Public Health, Environmental and Occupational Health


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