Table 6 Potential reasons for disinvestment in the local healthcare setting

External

 ▪ To address political priorities

 ▪ To meet legislative, regulatory or accreditation requirements and professional standards

 ▪ To meet national recommendations

 ▪ To address legal and ethical issues

 ▪ To be sensitive to the environment

Financial

 ▪ To save money to meet budget cuts

 ▪ To find money to spend on something else

 ▪ To prioritise where money is spent

 ▪ To redistribute within or between budgets

 ▪ To support investment in new technologies

 ▪ To support continued investment

 ▪ To get value for money

Economic

 ▪ To maximise benefits from resource use

 ▪ To improve efficiency

 ▪ To maintain quality without extra expenditure

 ▪ To remove TCPs with unacceptable cost per QALY

Organisational

 ▪ To meet strategic goals and priorities

 ▪ To ensure sustainability

 ▪ To increase productivity

 ▪ To work within organisational capacity

 ▪ To work within staff capability

 ▪ To rationalise services eg only provide orthopaedics at hospital A and oncology at hospital B

 ▪ To enable system redesign

 ▪ To reduce health service utilisation

 ▪ To reduce risk to staff, finances or reputation

 ▪ To reduce waste

 ▪ To address specific problems

Patient care

 ▪ To improve patient health outcomes

 ▪ To reduce patient harm

 ▪ To target populations or indications for best results

 ▪ To improve patient flow and reduce waiting times

 ▪ To improve patient satisfaction or reduce inconvenience

 ▪ To improve patient access and equity of service provision

 ▪ To reduce unnecessary tests or treatment

Health technology, clinical practice or service

 ▪ To keep equipment up-to-date

 ▪ To remove obsolete or superseded technology

 ▪ To remove or restrict TCPs that are harmful

 ▪ To remove or restrict TCPs that have little or no value

 ▪ To replace TCPs with alternatives of greater benefit

 ▪ To remove services that are not performing as intended

 ▪ To remove services that are not meeting the needs of the target population

Evidence Based Practice

 ▪ To ensure practice is consistent with current evidence

 ▪ To actively identify evidence of harm or lack of effect and remove relevant TCPs

 ▪ To update evidence-based guidelines and protocols

Social judgement

 ▪ To ensure public funds are spent wisely

 ▪ To reduce public funding on discretionary services eg some cosmetic procedures