Enable more NHS organisations to become mutuals and devolve decision-making, says independent review

An independent review for the government has concluded that more NHS organisations should be encouraged to become public service mutuals.

The review, led by Chris Ham, Chief Executive of The King’s Fund, found compelling evidence that NHS organisations with high levels of staff engagement – where staff are strongly committed to their work and involved in decision-making – deliver better quality care. Organisations with high levels of staff engagement report: 

  • lower mortality rates 
  • better patient experience
  • lower rates of sickness absence and staff turnover.

Organisations with low levels of staff engagement are more likely to provide poor-quality care – the failures in care at Mid Staffordshire NHS Foundation Trust are one high-profile example of this.

While staff engagement levels have increased across the NHS in recent years, the review found significant variations between organisations. It calls on all NHS organisations to make staff engagement a key priority in order to improve care at a time of unprecedented financial and service pressures.

The review found emerging evidence that, by giving employees a stronger stake in their organisation, public service mutuals deliver higher levels of staff engagement. This was reinforced by testimony from leaders and staff working for mutual organisations that they feel a strong sense of ownership and empowerment, leading to better organisational performance.

As a result of this evidence, the review recommends greater freedom for NHS organisations – including hospitals – to become mutuals, on a voluntary basis. It calls on the government to launch a programme of pathfinders to gather further evidence about the benefits of mutuals and whether they could be adopted on a larger scale across the NHS.

The review also highlights the need for more proportionate regulation to reduce the burden on NHS providers to report to national bodies. It calls on the government and regulators to devolve more responsibility to NHS organisations to create headroom for local NHS leaders to bring about improvements in care.

Chris Ham, Chair of the review, said: ‘The evidence that more engaged staff deliver higher quality care is compelling – a simple truth that should be acted on by all NHS organisations. Increasing staff engagement is first and foremost the responsibility of NHS leaders, from the board to the ward. But it is also time to give serious consideration to the role public service mutuals could play in increasing staff engagement and delivering benefits to patients. This should be accompanied by more proportionate regulation so that NHS organisations can look out to their patients, staff and stakeholders, rather than up to national bodies.’

Notes to editors: 

The Review of Staff Engagement and Empowerment in the NHS was jointly commissioned by the Minister for Care and Support, Norman Lamb MP and the Minister for the Cabinet Office, Rt Hon Francis Maude MP in November 2013. It was chaired by Chris Ham, Chief Executive of The King's Fund, and supported by a panel of 17 experts.

For further information about the review or to request an interview with Chris Ham, please ring The King's Fund's press office on 020 7307 2585.

The government's response to the review is being co-ordinated by the Department of Health. For further information, please contact the Department's press office on 020 7210 5301.