Centralisation of specialist health care services: a mixed-methods programme

There have been significant changes in the provision of specialist clinical care in the NHS in recent years, with plans to centralise specialist services into fewer centres. Specialist services are not available in every hospital because specialist teams of health care professionals with the required knowledge, skills and experience usually deliver them.

There have been longstanding recommendations for centralisation of specialist services. The aims of this study are to use quantitative and qualitative research methods to investigate (a) how the centralisation of specialist health care services in the UK can be characterised, (b) how different approaches/models to centralisation might work better in different settings, and (c) whether and how patients, general population, health care professionals, hospital managers and commissioners would prefer specialist health care services to be centralised.

The objectives are:

O1. To undertake a novel scoping review to identify what “centralisation” as a service innovation means in the context of specialist health care services, and what the dimensions of centralisation are. O2. To use the scoping review to develop a taxonomy to map the different models of centralisation.

O3. To identify in conjunction with the funder and NHSE&I specific conditions of interest for centralisation of specialist health care services in England and conduct original discrete choice experiments (DCEs) to analyse the preferences of patients, general population, health care professionals, hospital managers and commissioners.

The associated research questions are:

RQ1: What are the general features and dimensions of ‘centralisation’ of specialist health care services as a service innovation? RQ2: How might centralisations of specialist health care services be classified?

RQ3: What are the preferences of patients, general population, health care professionals, hospital managers and commissioners for centralised specialist health care services?

For RQ1 we will undertake a scoping review to identify the key components of centralisation for specialist health care services in the context of service innovation. This scoping review will map the diverse body of published and grey literature that exists around the main features of centralisation for specialised services. For RQ2 we will use the scoping review to develop a taxonomy of different models of centralisation.

Using the findings of the scoping review plus other most specific reviews, for RQ3 we will conduct discrete choice experiments to elicit preferences for centralisation of selected specialist health care services of key stakeholder groups.

Note that this study is the core of a wider proposed programme of research, which will include one or more empirical studies to evaluate the impact of centralising specialist health care services in specific clinical domains. These evaluations will overlap the current study and could include evidence reviews of the effectiveness and cost-effectiveness of centralisation, impact evaluations on patient outcomes, processes of care, and costs and cost-effectiveness, evaluations of stakeholder preferences, implementation studies.

The proposed research will be developed in partnership with research users, to maximise its usefulness and impact. It will provide new data for research users on what patients, general population, health care professionals, hospital managers and commissioners think about the centralisation of specialist services, which issues matter to them the most when considering this, how strongly they feel about these issues, and their preferences with regard to the centralisation of specialised services.

We will discuss the key components of centralisation of specialist health care services by developing a taxonomy that could be used by other research teams exploring centralisation in other healthcare contexts/specialties. Results of this research will inform policy makers and other research users on how the centralisation of specialist services might be best organised around the needs and preferences of main stakeholders.