Decommissioning services is never easy, and it can become a complex, sensitive and contentious issue that CCGs will have to navigate in relation to working with other healthcare organisations, as well as other stakeholders and the wider community.
However difficult it may seem, if decommissioning is the right thing to do in terms of improving healthcare, CCGs need to be prepared to work their way through the necessary changes and galvanise support on the way.
The key here is transparency: What are you trying to achieve? Why decommissioning is the answer? What are the results you expect to get?
The starting point could well be signalling how this initiative fits in with the commissioning intentions set in your operational plans and how this is the right process which also fulfils the Lansley's four tests for reconfiguration: clarity on clinical evidence base; consistent with patient choice; balance of evidence and stakeholder views in support of change; and strengthen public and patient engagement.
Your initiative will have to be devised in a way that helps you deliver services in line with the needs assessment agreed in the health and wellbeing strategy. This should help you get support from the Health and Wellbeing Board.
You need a robust leadership strategy which enables your CCG to involve everyone concerned from the outset and which fosters clear communication.
Ideally, your decommissioning strategy will be focused on clinical outcomes. You may find that your local acute services are resistant to change, as they may suffer a negative impact as a result. So you need to make a strong case on which to develop your plan. Don't try to do this in isolation; enlist help of clinicians and other experts.
For example, if you are planning to decommission a diabetes service, you could enrol the support of a diabetologist, not necessarily from your local trust, who could serve as a useful lever. You need to think through the reasons for change: What is wrong with service now? Are there any quality issues? Is accessibility a problem for patients? In this way, you develop a platform to ensure that people can see there is a problem that needs to be solved and that your CCG has devised a solution.
If you are proposing a significant change that will require formal consultation, an option would be to involve key stakeholders in working out the case for change and test this out in a small group first.
Keep the message simple and align stakeholders' interests. Work through your communications plan carefully, considering your audiences and the most effective way to get the message across to them. The language you use will vary according to your audience, i.e. member practices, the community, the Health and Wellbeing Board, local politicians.
Try to build a coalition for change, which includes influential people in your community. Remember that party politics can detract from the real reasons for change, especially if the local authority has a different political colour from the national party.
If you encounter a lot of resistance to the proposed changes, you will need to work a lot harder. You need to know how high a mountain you need to climb before starting the journey. This is a crucial part of the process in which you assess the support your CCG already has, your engagement strategy, and the strength of your coalition for change.
And remember that the Overview and Scrutiny Committee will play a key role in the formal process by scrutinising everything you do.
In summary, you need to have a clear and compelling vision, a realistic assessment of capability and capacity, so that you can enlist external help where necessary, and a step-by-step project plan that propels you in the right direction.
At the end of the day, CCGs' role will be to provide and redesign services focusing on local needs. Inevitably for some, this will mean decommissioning services from acute trusts. The path may not be straightforward, and a compelling vision that combines better results for patients and delivers results in line with local and national strategies will give you focus and a strong rationale for change.
Julie Wood is the National Director of Clinical Commissioning, NHS Alliance
