The Dalton Review: Change is not optional

Published 15 December 2014

The pressure on NHS providers to improve performance whilst also embracing rapid transformative change shows no sign of abating.

Sir David Dalton’s Review “Examining new options and opportunities for providers of NHS Care” was published on Friday 5th December 2014. The Review sets out a number of recommendations focussed on achieving a greater consistency of quality across NHS service provision, assisted by speeding up the transactions required to implement the required models of care.

5 Things you should know about the Dalton Review

1. One size does not fit all

No prescribed organisational form should be nationally dictated to providers - local circumstances should inform any proposed solution.

2. Quicker transformational and transactional change is required

The regulatory landscape to change organisational forms can be complicated, leading to resource draining and complex transactional processes. This often deters providers from engaging in transactions at all, stifling change. Save in exceptional circumstances, all transactions should be completed within one year from the date of approval of Monitor and/or the NHS TDA .

3. Ambitious organisations with a proven track record should be encouraged to expand their reach and have a greater impact

Ambitious and successful organisations wishing to 'spread their wings' should be 'credentialed' thereby allowing them to bid to take on the management of and/or acquire challenged organisations.

4. Overall sustainability of the provider sector is a priority

The Review recognises that the FT pipeline is in a logjam. If implemented, the actual categorisation of the remaining 93 NHS Trusts and their plans for sustainability will be published (although there is no definite timescale for this in the Review). Where NHS Trusts are categorised as not being in a position to reach FT status in their current form, batched procurements are suggested for mergers/acquisitions of those organisations, or other management arrangements such as franchising or management contracts.

5. A dedicated implementation plan is needed to make change happen

Frontrunner organisations with well-developed plans for a new organisational form should be supported to become 'demonstrator sites', who would then share learning with other providers to facilitate wider and faster adoption over time.

Supporting implementation – how we can help

We welcome the Dalton Review, as it sets out a clear recommendation for the implementation of a framework giving NHS providers more flexibility in developing local solutions to improve local patient care.

We are developing a web-based resource for providers seeking to understand more about the legal implications of the various models set out in the Dalton Review, with case studies of the projects we have been involved in.

We work with organisations who are already implementing this agenda:

• We are currently engaged on a number of integration projects nationally, including between primary, community and secondary providers (vertically and horizontally), and we are able to share and implement learning from these projects with our clients;
• We have recently carried out research with a number of key integration contacts in the NHS in order to produce our own analysis – read the resulting report;
• We are working with system architects nationally to design and implement new organisational forms (for example, forerunners to primary and acute care systems nationally, as well as the flagship North West London Whole Systems Integration Programme);
• We are helping a number of NHS providers to prepare for becoming credentialed organisations;
• We are providing training to Boards on the implications of different legal forms for NHS providers;
• We have significant experience and expertise in advising commissioners on managing conflicts of interest.