1. ‘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
Kerry Allen HSMC

2. Background to the study
•Concerns raised over the failing
Southern Cross care home company
•A number of LA have significant
experience of managing care home
closures
•Directors of Adult Social Services
(ADASS) and government wanted to
gain insight into such practice based
knowledge
•commissioned by ADASS and
formed part of a wider project that
was tasked with developing
guidelines for those undertaking
care home closures.

3. Interviews focused on the following:
 ADASS identified a  Directors’ and LA experience of
number of organisations managing care home closures.
and directors who had  Nature and scale of the closure
extensive experience of programme
 Principles, processes and mechanisms
home closures. used locally
 Whether or not they had local
guidelines and how helpful/current
 The research team then these seemed.
approached each  What impact the closures seemed to
have different groups
director individually via  Lessons they learned about what
email to request constitutes good practice.
permission to conduct  Key barriers and success factors.
an in-depth telephone  What advice they would give to others
interview. facing a similar situations (including
their top three priorities for others).
 What would help in terms of future
policy or resources.

4. Decision making policies and procedures
Communication and information
Stakeholder involvement and collation
building
Leadership

5. Decision making policies and procedures
 No disinvestment decision is  clear transparent decision
easy or popular, having local making processes - important
policy guidance that is for the legitimisation and
perceived as fair and defence against legal or other
reasonable was advocated by challenge
those involved in home
closures  authorities need to be clear
 Many local policies had on their policy and decision
evolved over time -often making sure this message is
been developed following correctly communicated to
experiences of home closures the wider stakeholder groups,
(both good and bad).
 Also important to have a
media strategy.

6. Communication and information
 Need to have robust  decisions to disinvest in
evidence to support a service can have a
decisions ‘knock-on’ effect on
 great emphasis was other services
placed on being honest  Thus, need to examine
and open with how a home closure
stakeholders about may impact on other
why the decision to services across the
decommission a region.
service is taking place.

7. Stakeholder involvement and
collation building
 Requirement of public  Whilst involvement of
sector agencies to stakeholders groups was
manage their crucial it was also felt
authorising that once the decision to
environments- that is close a home had been
the key stakeholder made and
groups whose support is communicated to
required if rationing and stakeholders, then it was
disinvestment decisions important to implement
are to be considered the decision within the
legitimate. given timescales.

8. Leadership
 Process of leadership  middle tier of managers (in
needs to be led and owned this case assessors) play an
by the senior management important role in
team overseeing the
 leadership tasks pertain to implementation process
more complex,
relationship-based issues  Thus lessons here are
 influencing others, engaging around the distinct roles of
key stakeholders etc), leaders around policy
 this involves skills such as development.
 creating alignment between
stakeholders, fostering vision
and mobilising support for
change.

9.  Disinvestment is difficult and complex
 Sharing best practice guidance and policy around
what works is important
 working with the authorising environment is key to
helping to legitimise the decision and reduce the
negative fallout following disinvestment decisions.
 some of the challenges facing decision makers
include:
 the need to develop and adopt fair decision making
processes;
 the creation of a coalition of support;
 the need to manage and negotiate the political hazards
and fallout associated with the withdrawal of services.

10.  Given the financial challenge
learning from each other about
what works when
decommissioning services seems
crucial
 decommissioning decisions should
be influenced by what we know
about what constitutes best
practice
 Where we lack detailed
knowledge about what works
within our own service or sector,
there may often be similar
examples and significant expertise
in other areas/sectors – and we
neglect this at our peril.