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

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  • University of Pennsylvania


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)1-25
JournalSociology of Health and Illness
Issue number00
Publication statusPublished - 26 Feb 2021