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The decommissioning of a health‐care service is invariably a highly complex and contentious process which faces many implementation challenges. There has been little specific theorisation of this phenomena, although insights can be transferred from wider literatures on policy implementation and change processes. In this paper, we present findings from empirical case studies of three decommissioning processes initiated in the English National Health Service. We apply Levine's (1979, Public Administration Review, 39(2), 179–183) typology of decommissioning drivers and insights from the empirical literature on pluralistic health‐care contexts, complex change processes and institutional constraints. Data include interviews, non‐participant observation and documents analysis. Alongside familiar patterns of pluralism and political partisanship, our results suggest the important role played by institutional factors in determining the outcome of decommissioning processes and in particular the prior requirement of political vulnerability for services to be successfully closed. Factors linked to the extent of such vulnerability include the scale of the proposed changes and extent to which they are supported at the macrolevel. [ABSTRACT FROM AUTHOR]

Recent UK health policy initiatives promote a ‘no blame culture’ and learning from adverse events to enhance patient safety in the NHS. Similar initiatives exist in the USA and Australia. Changing the ‘blame culture’ in the NHS has been advocated in policy documents and inquiry reports for over a decade. Some key concepts that are used in the policy discourse –‘blame’; mistakes, errors and misdemeanours; and ‘culture’– are examined and considered in the light of pertinent social science literature to question some of the assumptions concerning these terms in the policy discourse, and to suggest some alternative questions and perspectives. The Three Inquiries, a recent series of statutory inquiries held in the UK, are used as a case study to explore some of the intra- and inter-professional difficulties of reporting errors and misconduct by medical practitioners. The paper offers an interpretive social science perspective as an alternative to more policy oriented and managerial approaches to patient safety issues, focusing on deeper structural aspects of organisational phenomena implicated in the ability or otherwise of medical and other healthcare staff to report mistakes and misconduct as one aspect of patient safety. [ABSTRACT FROM AUTHOR]