Dalton Review Final report published on 5 December

Trust signpost

08 / 12 / 2014 2.30am

The Department of Health has published the results of the review led by Sir David Dalton which looked at the need for new forms of organisation in the NHS. The review argues that in order to help reduce variations in care, improve quality and help find the savings demanded from the NHS there needs to be a move toward a range of new forms and structures in the NHS. In particular: -

  • one size does not fit all
  • quicker transformational change and transactional change is required 
  • ambitious organisations with a proven track record should be encouraged to expand their reach and have greater impact across the sector
  • overall sustainability for the provider sector is a priority
  • change must happen - implementation must be supported

Workforce dimension

The review highlights workforce challenges arising from current arrangements. For example: -

"Over recent years it has become apparent that some organisations struggle to attract the right quality of clinical workforce, which has compounded the issues of clinical variation for trusts that are already challenged. The evidence shows that staff engagement has significant associations with patient satisfaction, patient mortality, infection rates as well as staff absenteeism and turnover.

In addition, recruitment of enough staff with the right skills to universally meet the seven day working requirements against predicted levels of future demand will prove an ongoing challenge for  organisations.

It notes that in order to meet the challenge of maintaining high quality care “Trusts will need to think innovatively about how they redesign services and pool their workforce with neighbouring organisations in order to maintain clinical quality. The recent inspections that the Care Quality Commission has started to undertake demonstrate that leadership and culture have a significant impact on other areas of quality. Its early findings show that being well-led correlates well with the overall rating of quality.”

This review encourages boards to consider fundamentally whether their existing form is best designed to deliver new models of care and ensure the delivery of required standards.”

The approaches that could be taken are described as consolidation, contractural and collaboration.

The review looked at seven options for different organisational forms ranging from greater collaboration through to multi site hospital chains and Multi service Foundation Group. The options also include Joint Venture and managed contracts which could be operated with the independent sector. The Review also suggests that a mutual model could apply to any of the organisational structures outlined.

The review calls for changes to the way that national regulatory bodies address these issues to support change and in particular calls for a number of “demonstrator sites” to be developed to test the ideas.

There will be workforce issues arising from these organisational changes. In particular experience suggests that there will be challenges in sustaining staff engagement where organisations merge especially if there is a perception of a take over. In multi site and chain organisations there will be a need to ensure consistency in standards across the sites. Managements contracts create an employment relationship where staff are managed by the independent sector but remain NHS Employees. NHS Employers will highlight key developments as implementation proceeds.

The NHS Confederation has produced extensive  analysis of the review which can be found here.

Full links to the review and associated materials can be found here.

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