The Dalton Review. Summary for NHS Confederation members. 05 December 2015

Transcription

1 The Dalton Review Summary for NHS Confederation members 05 December 2015

2 The Dalton Review Commissioned by the Health Secretary in February 2014 to explore options for providers of NHS care and to "reduce variations in clinical standards, financial performance and patient safety". The principle guiding the Review is that all patients should expect to receive the same high standards of care, no matter where or in what setting. Aims to encourage boards to explore how new organisational models can help safeguard an organisation s ability to provide safe and high quality care. It makes recommendations for boards and national bodies which aim to make changes easier and quicker.

3 Key points There are no right or wrong organisational forms it is down to the system leader to choose the model that will deliver the greatest patient benefit for their local population. Leaders of successful organisations should be system architects developing innovative solutions for their local area and sharing their success. A system of credentialing for the best organisations should be taken forward, building on Monitor and CQC s work, to enable commissioners to identify those organisations with the greatest capacity for sharing their success and helping those organisations in persistent difficulty.

4 Competition law must not be seen as a barrier to developing organisational solutions. Patient benefit should decide what new organisational form to pursue. Boards should develop an Enterprise Strategy to utilise innovative approaches to deliver better care for patients and develop the internal capacity required to do this. National bodies need to accelerate change by supporting the costs of initial transactions.

5 Recommendations The report makes 22 recommendations to national bodies, clinical commissioning groups (CCGs), NHS leaders and wider organisations, which break down into five themes: 1. one size does not fit all 2. quicker transformational change and transactional change is required 3. ambitious organisations with a proven track record should be encouraged to expand their reach and have a greater impact across the sector 4. overall sustainability for the provider sector is a priority 5. change must happen - implementation must be supported.

6 1. One size does not fit all A broader range of options for organisational forms should be considered, recognising the evidence from the review which has demonstrated that effective use of different organisational forms can help support the reliable delivery of high quality care. No single form is the answer, this should be locally determined, avoid top-down solutions, whilst recognising that multiple forms can co-exist in one entity. There is evidence to suggest that changing organisational forms will drive improvements but execution is key to turning potential benefits into actual gains.

7 New organisational models could be in the form of: Organisational model Collaborative models Contractual models Consolidation models Other options Bring together two or more organisations voluntarily to pool resources and achieve better outcomes. e.g. Federation or joint venture More formalised agreements with performance and quality standards agreed as part of the arrangement. e.g. Service level chains and management contracts Change of ownership with new organisation coming in to being potentially providing different services e.g. ICO, M&A, Multi-site trust and foundation group Buddying, informal partnering and clinical/strategic networks, mutual social enterprises

8 Trust boards Recommendation As part of the 2015/16 business planning process, trust boards should consider their response to the NHS Five Year Forward View and determine the scale and scope of their service portfolios. They should consider whether a new organisational form may be most suited to support the delivery of safe, reliable, high quality and economically viable services for their populations. Trust boards Trust boards of successful and ambitious organisations should develop an enterprise strategy and should consider developing a standard operating model that could be transferred to another organisation or wider system.

9 2. Quicker transformational change and transactional change is required Commissioners and the wider system need to work with providers to engage with patients to determine sustainable service models. All parties should act on the Five year forward view commitment that says we will now work with local community and leaders to identify what changes are needed in how national and local organisations best work together. Transactions should take no longer than a year to complete, the amount of time taken could be reduced through standardised documentation and a unified process with clear guidance. A new status, to which the most successful organisations can aspire, could help reignite an entrepreneurial spirit similar to that which existed in the first wave of FT authorisations.

10 NHS England and CCGs Department of Health Department of Health, Monitor and TDA Secretary of State for Health Recommendation NHS England should require Clinical Commissioning Groups (CCGs) to set out in their five year strategic commissioning plans: a. the future care/service models they wish to support; and, b. how they will use their allocated funds for service transformation to support providers to deliver the agreed transformational and organisational change. Where multiple CCGs and providers are taking forward service transformation across a shared geographical area, NHS England should help broker agreement as to how costs are met between all parties. A single, unified process with standardised documentation outlining clear criteria should be developed to support future transactions. This should include guidance for all parties including Governors. A Tender Prospectus that has the parameters of the transaction clearly laid out should be made available to all potential bidders in the interests of speed and transparency. The Secretary of State should set a requirement to the national bodies that, except in exceptional circumstances, all transactions should be completed within one year or less from the time the decision is taken by the board of the NHS Trust Development Authority (TDA) or Monitor.

11 3. Ambitious organisations with a proven track record should be encouraged to expand their reach and have a greater impact across the sector Transformational change requires strong and capable leadership. Leaders of successful organisations should become system architects, encouraged to develop innovative organisational models and spread best practice to other local areas. We should support these successful organisations to develop enterprise strategies and develop new incentives to encourage them to work with less successful ones.

12 Monitor and CQC Monitor and CQC CCGs and providers Monitor and the TDA Recommendation A new credentialing process, to recognise successful organisations capable of spreading their systems and processes to other organisations, should be developed by July This should build on CQC and Monitor ratings, with a good or outstanding rating a prerequisite. Once agreed, Monitor should be responsible for the process and the first wave of credentialing should be completed by October A list of all credentialed organisations should be published on both Monitor and the CQC websites and made available to every Clinical Commissioning Group. CCGs and providers should use this list of credentialed organisations to identify new partner organisations most likely to deliver transformational improvement. A procurement framework should be developed which allows interested credentialed organisations the ability to register for management contract and acquisition opportunities. This framework should be live from or before April Inclusion on this register would mean that an organisation automatically passes the prequalification questionnaire (PQQ) stage of any tendering processes. The framework should then be used by the TDA and Monitor to procure support for challenged organisations.

13 Trust boards Leadership Academy Department of Health, Monitor and CQC Monitor and the TDA Recommendation Trust boards should consider new operational and strategic leadership roles required in order to support the new organisational models, and put development plans in place accordingly. The Leadership Academy should support the development of the requisite skills and experience for the new operational and leadership roles and build these into the career paths and leadership and development training of current and future NHS leaders. The Department of Health, Monitor and the CQC should agree a grace period for acquiring organisation with an agreed trajectory of finance, performance and quality standards improvement for the acquired or contractually managed organisation, separate from the overall performance of the combined organisations. This grace period should take into account historical quality issues and the impact of any agreed financial investment adjustments. Monitor and the TDA should ensure that where appropriate an acquiring or contractually managed organisation can start to create integrated operational structures, once the Heads of Terms have been agreed, so that these may be run in shadow form prior to the final decision on the transaction being taken.

14 4. Overall sustainability for the provider sector is a priority Only a proportion of the current 93 NHS Trusts will become Foundation Trusts (FTs). Some of those that are already FTs would not reach the required standards for authorisation today, being both clinically and financially challenged. These organisations need long term solutions, supported by appropriate governance models, to enable them to carry out the best possible care for patients

15 TDA Department of Health TDA Monitor and TDA Monitor Recommendation Publish the categorisation of and plans for each of the 93 NHS Trusts in the pipeline, along with the trajectory and milestones for when and how they will achieve FT status or another sustainable organisational form. Hold the TDA to account for meeting the trajectory and milestones for each of the 93 NHS Trusts. Make available solutions for those patients and communities who are receiving care from organisations in persistent difficulty, by running batched procurements for category B1 and B21 NHS Trusts. Expand the buddying system beyond the special measures trust into a partnering system to enable organisations with the potential to improve to get the support and guidance to do so. Make arrangements to identify those Trusts capable of providing support and remunerate them to do so. Use their existing categorisation process to drive more rapid interventions. Where Monitor determines a FT is in persistent difficulty it should require that FT to produce a plan outlining improvements and the timescale to carry this out. If the FT cannot match this plan then Monitor can compel them to produce another sustainability plan, which can include the adoption of a new organisation form or the pursuit of a transaction with a credentialed organisation.

16 5. Change must happen - implementation must be supported Two things need to happen if the recommendations in this report are to be implemented successfully: 1. NHS leaders need to be supported to have understanding of the models available to them and how to best implement them. This requires a programme of best practice which the NHS Confederation will play a key role in. 2. There should be a programme of demonstrator sites which can simulate and accelerate change and which will support providers to develop and test new organisational forms in practice.

17 Department of Health Recommendation The evidence and the findings from the Review should be communicated across the health sector, alongside the business planning round. This should be done through a national programme of learning and sharing best practice. Department of Health, Monitor and TDA The national bodies should support these demonstrator sites which test and implement change to an organisation s form.

18 NHS Confederation s input into the Review The NHS Confederation was represented in the membership of the review panel: Rob Webster, chief executive, NHS Confederation Stephen Dalton, chief executive, Mental Health Network Dr Mark Newbold, chair of the NHS Confederation s Hospitals Forum Jim Easton, managing director health care, Care UK, representing NHS Partners Network

19 Two of the 2015 Challenge Manifesto key asks have been reflected in the Review: Ask 3: the Government must avoid mandatory on size fits all models of reform. Change must be driven locally and must reflect local people s needs and aspirations. Ask 5: the Government and national bodies must make available a range of organisational models for providers, including small providers from the voluntary and community sector to enable them to deliver clinically and financially sustainable services and reflect the needs and aspirations of local users and communities.

20 Government response The Government welcomes the Review and its recommendations, encourages all those working in or with the NHS to consider the options and recommendations of the Review and will take a close interest in their adoption and implementation over the coming months. Jeremy Hunt, in a statement to the House of Commons, 5 December 2014

21 NHS Confederation response This is a landmark report for the NHS and for providers of NHS care. I am proud to have been part of the Expert Panel that supported the report and look forward to supporting its implementation through the NHS Confederation. Read our full statement

22 Next steps The NHS Confederation is working jointly with NHS Providers and the Dalton Review team on the implementation of Review. Over the coming weeks and months we will be engaging with members from across the system to enable NHS organisations to learn more about the recommendations of the Review and how they might work in practice. As part of this we will be running a programme of events, publications and online tools.

23 Along with NHS Providers, we have agreed to lead a programme of education and dissemination. This will include distilling evidence packs into sector friendly how to guides to help boards consider these options in more detail, to be launched early next year. The government is creating a 200m transformation fund in to deliver the first year of the Five year forward view. The fund will aim to kick-start the work needed to develop new ways of caring for patients to improve the integration of GPs, community services and hospitals.

24 More information available at: To read the full report: