Decommissioning Health Services

The NHS is facing an inevitable period of change. Backlogs accumulated during COVID persist, and ministers are under growing pressure to improve elective waiting times, diagnostics, and emergency care. Expectations around service delivery and transparency are rising. In this context, how services are decommissioned or merged will influence public trust for future changes.  

This insight article outlines what’s different now, why early moves matter more than ever, and the practical tests leaders should apply before taking their first step. Use it alongside tCI’s new Decommissioning Check List (August 2025) as the working asset on your page.

What has changed since the last major wave of reconfigurations?

1) The centre can intervene promptly. Since 31 January 2024, NHS commissioners must notify certain reconfigurations to the Department of Health and Social Care; the Secretary of State can call in proposals and make (or reassert) decisions even if the changes are not significant. This emphasises the importance of early engagement, clarity on alternative options, and maintaining a clear audit trail as more than just good practice. However, it is noted that this power has been used very sparingly to date.

2) Procurement and service change are now closely linked. The Provider Selection Regime came into effect on 1 January 2024, and the statutory guidance was updated in April 2025. If a cessation results in a new or modified provider model, your PSR record (criteria, conflicts, standstill, representations) will be reviewed alongside your engagement file.

3) Scrutiny is ongoing, not seasonal. NHS England highlights record treatment volumes and some progress on waiting times, but there will always be public and media attention. That context raises the standard for plain-English explanations and credible mitigations.

Why the first decommissioning sets a precedent

When a system acts, it sets a template that others will follow or oppose. If the initial decommissioning in your area seems rushed or unclear, future proposals will be judged on that perception and may face organised opposition. Do it well, and you create space for proportional change.

Think of it as a three-part test for legitimacy:

Is the story recognisable to the public?
Not just facts, but a narrative people can relate to through their own experiences: pressure on staffing, safety risks, duplication that spreads teams too thin. Independent surveys show public opinions are nuanced; they will accept change when explanations and mitigations are reasonable.

Were real options on the table?
You don’t need a glossy options appraisal to show a do-minimum and at least one credible alternative—and why they’re not preferred. That single step serves as a fairness signal that defuses accusations of a “done deal”.

Do mitigations target the areas where harm occurs?
Inequalities continue to be the key political and ethical issue. If travel times, digital access, or workforce changes disproportionately impact Core20PLUS5 groups, your mitigations (transport, outreach, alternative pathways) must be clear, budgeted, and time-specific—not just listed.

What works and why?

Based on what we are observing across systems, three tactics consistently reduce noise and escalation risk.

• Write the “reasons, impacts, alternatives” page first. Before beginning the design work in earnest, create a one-page document in straightforward English that addresses these three questions and review it with stakeholders. It forms the core of the project.
• Publish your trail, not just your ask. The checklist below outlines what we believe should be in the trail – however, each context is different. 
• Set time limits for “urgent” moves and specify when you will report back. If you need a patient-safety change quickly, commit publicly to review points and publish brief, dated updates. This fosters trust during winter pressures and prevents “temporary” changes from becoming permanent.

Download our checklist to support the development of your proposals.