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05.12.14

Dalton review outlines plans to accelerate conversion of foundation trusts

A government commissioned review into NHS provider policy has recommended a number of measures to accelerate the pipeline of would-be foundation trusts.

The Dalton review, published this morning, concludes that “many” of the 93 trusts that have not yet reached foundation status “will not reach the required standards in their current organisational form”. It identifies a number of organisational forms that have the potential to be adopted across the wider NHS. Many of these are already in use by different providers, but the report stresses that there is “no national blueprint”: what matters is what works locally.

Led by Salford Royal Foundation Trust chief executive Sir David Dalton, the review determined that the extent of variation of standards of care across the country and the challenges all providers of NHS services face must be addressed as soon as possible. It says that the NHS Five Year Forward View acts as a signpost to organisations to consider new and innovative solutions to address quality and financial challenges.

The review identifies five key themes and says that addressing these will accelerate the transformational change that is required to help overcome the challenges facing the NHS.

The themes it identifies are:

  1. One size does not fit all
  2. Quicker transformational and transactional change is required
  3. Ambitious organisations with a proven track record should be encouraged to expand their reach and have
  4. Greater impact
  5. Overall sustainability for the provider sector is a priority
  6. A dedicated implementation programme is needed to make change happen

The review considered a number of organisational forms that have the potential for wider adoption across NHS providers: federations, joint ventures, service level chains, management contracts, integrated care organisations and multi-service chains or Foundation Groups.

In the future, it suggests, organisations are likely to operate more than one organisational form for their service portfolio. It recommends that trust boards consider whether a new organisational form may be most suited to support the delivery of safe, reliable, high quality and economically viable services.

It says that the NHS Trust Development Authority should publish its assessment of the capacity of each of the 93 organisations capacity to reach FT status, the organisations’ plans, and the dates by which they will achieve FT status or another “suitable organisational form”.

Adding that the Department of Health should hold the TDA to account for “meeting the trajectory and milestones for each of the 93 organisations”.

The review also recommends that NHS England require CCGs to set out in their strategic commissioning plans the future service models they wish to support and how they will use allocated funds for service transformation.

NHS Clinical Commissioners welcomed the report. Director Julie Wood said: “The Dalton Report is a vital part of the process to move the NHS to a more secure and sustainable place and the recommendations clearly sit alongside the Five Year Forward View ambitions. NHSCC welcomes the assertion that one size does not fit all and the overarching theme of the report to allow local health systems to work together to find the right local solutions for their patients and populations. Utilising all the funds that are available across whole local health systems, including any accumulated cash surpluses held by trusts will be critical.

“Sir David’s recommendation that national bodies and the wider system needs to accelerate its approach to transformation and change will be welcomed by our members - CCGs are already working hard to innovate and deliver new models of care so to have the whole system working at the same pace will ensure that patients benefit.”

Rob Webster of the NHS Confederation was on the expert panel that put together the recommendations.

He said: “At its heart, this review is about two simple things. Firstly, that we must tackle variations in quality of care that we provide. And secondly, that there are no right or wrong organisational form, what matters is what works.

“Many members – from all sectors of commissioning and all types of provision - will read the report and be supportive of the permissive approach being taken. I have heard much in the last few months of how provider members are working to understand how they remain sustainable into the next 5 years. They are working across mental health, acute, community and GP boundaries. They are collaborating as independent, NHS and voluntary sector organisations too.

“This report –building on the signals within the Five Year Forward View – has many of the answers that providers and commissioners will consider as they seek to decide on the right organisational form for their services in their economy for their patients.”

David Hare, chief executive of the NHS Partners Network, added: “It is now important that providers are given permission to test these new ways of working and that all options are on the table for sustaining a 21st century health service free at the point of use.”

(Image: David Dalton c. MAHSC)

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