Health Matters

Why World class decommissioning is more important than world class commissioning

On September 16^th the DH launched the second year of the World Class Commissioning Process. This is an important step forward in a number of ways.

• First, this is the first time the DH has recognised that improvement assurance systems require, if they are to really create improvement, needs iteration. It has to happen in a similar way every year so that people are not just randomly examined, but improve on an annual basis.
• Second, they have recognised that whilst the assurance process is very similar to last year with the same rhythm to the process, there are some stark differences to the development of a five year plan in the autumn of 2009 from the autumn of 2008 and these all concern the relationship between resource and outcomes. The same resource will have to buy much better outcomes.

So the process starts with a clear definition of what commissioning is all about.   

“Commissioning is the process by which primary care trusts (PCTs) procure health and care services to meet the needs of the population. World class commissioning (WCC) is transforming the way these services are commissioned, leading to improved health outcomes and reduction in health inequalities, adding life to years and years to life.”

Undoubtedly a great deal of what good PCTs do is to commission better health and health care for their population. That’s true. But equally important will be the processes through which they decommission services that are not necessarily adding health and health care or are doing so with expenditure that can buy better health and health care in a different way.

This is world class decommissioning. And it needs just as much skill and attention as world class commissioning.

From now onwards a PCT that is world class will have to stop buying health care or health improvement services with as much skill as it starts. And whilst commissioning itself is quite a new set of skills, world class decommissioning is much harder.

The NHS has a poor track record of stopping doing things. The whole history of reconfigurations is a history of very long and awful process with very little outcome. All over the country there are long war stories of attempts to close this dangerous service for decades. NHS managers end up blaming politicians, the public and doctors for keeping poor or inefficient services going. But whatever the set of causes, the reality is that in a large number of places the NHS has only stopped doing things, badly.

This has meant that since we are not good at stopping doing old things, we have done a number of new things that have been overlaid on continuing to do old things. This ensures that the people who continue to do the old things don’t get angry with us for introducing new things.

This has only been possible because we have had a lot of resource to allow us to do new things as well as the old things. If the money stops going we are left with a choice. We either stop doing new things OR we stop doing old things. We can’t do both.

So we either get good at stopping doing old things or we stop keeping up with new methods in medical technology.

Without world class decommissioning there can be no world class commissioning.