Table 4 Round one aggregated responses from 30 participants: best practice recommendations (listed in alphabetical order)

1

Adopt a whole systems perspective from the beginning

2

Base decisions on evidence of what works

3

Be pro-active in engaging with the media

4

Clear and thorough project planning and governance

5

Collect and analyse relevant data before, during and after

6

Do not decommission until alternative services in place

7

Engage and involve clinical leaders from an early stage

8

Engage and involve service users from an early stage

9

Ensure a transparent decision-making process

10

Establish a clear rationale and narrative for change

11

Establish clear criteria by which to measure outcomes

12

Focus on improved patient experience and quality

13

Identify and establish a strong top leadership team

14

Pay attention to the human elements of change and the impact that decommissioning can have on those involved

15

Pay equal attention to implementation and decision-making phases

16

Place emphasis on public engagement and communication

17

Provide regular feedback on progress

18

Resource the process and retain a budget for contingencies

19

Secure high-level political support (national and local) at early stage