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Table 2 Round one aggregated responses from 30 participants: considerations that (a) should and (b) do in practice inform decommissioning decisions (listed in alphabetical order)

From: Disentangling rhetoric and reality: an international Delphi study of factors and processes that facilitate the successful implementation of decisions to decommission healthcare services

Common considerations that both (a) should, and (b) do in practice inform decisions:

1

Addressing inequalities

2

Alignment with strategic priorities

3

Availability of alternative services/interventions

4

Capital costs/condition (buildings, maintenance)

5

Clinical effectiveness

6

Cost/budgetary pressures

7

Cost-effectiveness/efficient use of resources

8

Cost of implementation of decommissioning

9

Duplication of services

10

Equitable resource allocation

11

Evidence-base

12

Maximizing population health

13

New service developments/innovations

14

Patient and public views

15

Quality and patient safety

16

Responding to changing demographics/population needs

Additional considerations in practice:

1

Complexity of implementation of decommissioning

2

Government intervention, e.g., legislation

3

Impact on workforce

4

Marginal groups not heard (e.g., homeless)

5

Prejudice against public sector provision

6

Support from clinicians

7

Support from elected politicians

8

Support from industry and other interest groups