Future organisational models for the NHS: Perspectives for the Dalton review

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With a growing number of health care providers in deficit and others placed in special measures because of concerns about the quality of their care, the search is on to find ways in which they could be supported. Sir David Dalton’s forthcoming review provides a timely opportunity to explore the range of organisational models that providers could use to meet their current strategic and financial challenges.

This publication explores some of the organisational options available, including how high-performing NHS organisations might support providers in difficulty. It provides an evidence review and a range of individual perspectives on some of those new organisational arrangements, in health and other sectors, nationally and internationally – in a bid to inform the work of the Dalton review. The individual contributions highlight the benefits and challenges of different organisational models.

Key findings from the evidence review

  • The evidence suggests that most of the organisational models reviewed (buddying, learning and clinical networks, partnerships and joint ventures, managerial/operational franchise, mergers, and hospital chains) could help drive improvements in the quality of NHS services.
  • The higher the degree of organisational change, the higher the risk that the benefits will not be delivered (the evidence on mergers and acquisitions is pretty unequivocal that the risks from full-scale organisational change are high).
  • Common success factors across all the different organisational models include: good working relationships; a strong and shared focus on quality improvement that can be measured; and a focus on changing organisational culture.
  • The skills required to lead different organisational models are often different from those required to run a successful single institution.
  • There is also growing consensus that a trust’s problems cannot be solved without taking a whole system solution and perspective.

Policy implications

Strengthening leadership within the NHS holds the key to providing patients with access to high-quality care, and to helping those providers in difficulty turn things around. The current leaders of successful NHS organisations have had limited opportunities to work across wide geographies and within a ‘group’ management model. The tension between central and local control, and between the need for consistency and standardisation versus the capacity to innovate, are key issues for any chain or group model. Managing this tension will be new territory for many NHS chief executives.

Individual contributions

  • Brad Stoltz, Chief of Staff, Hospital Operations, Tenet Healthcare Corporation
  • Jonathon Fagge, Chief Executive, Norwich Clinical Commissioning Group
  • Dr Nick Marsden, Chairman, Salisbury NHS Foundation Trust
  • Mike Deegan, Chief Executive, Central Manchester University Hospitals NHS Foundation Trust
  • Steve Dunn, Director of Delivery and Development, NHS Trust Development Authority (TDA) (South region)
  • Steve Melton, Chief Executive Officer, Circle
  • Lucy Heller, Managing Director, ARK Schools
  • Dr Anthony Marsh, Chief Executive, West Midlands Ambulance Service NHS Foundation Trust and East of England Ambulance Service
  • Andy Brogan, Executive Director of Clinical Governance and Quality (Executive Nurse), South Essex Partnership University NHS Foundation Trust
  • David Hamlett, health care partner with Wragge Lawrence Graham and a non-executive director of University Hospitals Birmingham NHS Foundation Trust.


Phil Yates

GP Care
Comment date
06 July 2014
How can this piece of work have any legitimacy when it has had NO input from primary care in any shape or form? Another lost opportunity I'm afraid.

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