Developing new organisational structures in the NHS must be a priority if many providers are to become sustainable and healthcare improved.
This a key finding of the government commissioned Dalton Review, which suggests that one size does not fit all when it comes to organisational structure.
The long-awaited review finds that hospital chains, Hinchingbrooke-style management franchises and Moorfields-style service level chains, federations, joint ventures and integrated care organisations, should all be considered.
Quicker transformational and transactional change is required, it says, and a dedicated implementation programme is needed to make it happen.
Ambitious organisations with a proven track record should be encouraged to expand their reach and have greater impact.
The review, led by Salford Royal Foundation Trust chief executive Sir David Dalton, suggests “new organisational responses” will be needed to remove unacceptable variation in standards across NHS providers, and to implement the new models of care supported in the NHS Five Year Forward View.
It 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 recommends that the NHS Trust Development Authority should publish its assessment of each of those organisations’ capacity to reach FT status, the organisations’ plans, and the dates by which they will achieve FT status or another “suitable organisational form”.
The TDA would then be accountable to the Department of Health for delivering it.
The report states: “Leaders of successful organisations should become ‘system architects’, encouraged to use their entrepreneurial spirit to develop innovative organisational models and to codify and spread their success to other localities.
“Recognising these successful organisations, supporting them to develop enterprise strategies that expand their reach and developing new incentives will encourage more successful organisations to have greater impact with less successful ones.”
It further recommends that:
- the health secretary set a requirement on national NHS bodies that all transactions, such as mergers, takeovers, or franchises, should be completed in a year or less;
- Monitor and the Care Quality Commission should establish a new “credentialing” process to accredit successful organisations “capable of spreading their systems and processes to other organisations”;
- the first wave of organisations should be credentialed by October 2015.
The report concludes: “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.
“The NHS Five Year Forward View signposts organisations to consider new and innovative solutions to address quality and financial challenges; the recommendations of this review complement the NHS Five Year Forward View and support providers to deliver the changes required.
“Effective and speedy implementation is now required in order to have the greatest impact for patients. The government, national bodies and patients should have confidence in NHS leaders to make the necessary changes a reality.”