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New Options for Providers
Emerging thinking
Nuffield Trust – 9 June 2014
The Dalton Review

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Agenda
1. What, Why, How
2. Typology of models
3. Emerging key themes

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What? The purpose of the review
To provide new options and opportunities for providers of NHS care to
support their future clinical and economic sustainability.
The review will seek to develop a new range of options for new
organisational forms, that present real benefits and opportunities for
Boards, not create a national blueprint for the provider sector or promote
any one model.
What, Why, How

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Context: Providers face a familiar set of challenges
• Providers need the flexibility to work in new and innovative ways to improve
quality and become more efficient
• No single solution is a panacea – we need a range to apply to different situations.
• Solutions must come from organisations themselves but can be enabled by the
centre
In responding to these challenges…
Patients and public
expect high
standards and
access
Drive to improve
quality and safety
Ageing population
with increasing
LTCs
Financial
constraints and
forecast deficits
What, Why, How

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What, Why, How
Why consider Organisational form?
• Unrealised potential in the health sector
• Struggling providers
• Learning from approaches internationally
• Learning from other sectors

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How? The review will be open and consultative.
Dalton
Review
Think Tanks
• Health Foundation
• Nuffield Trust
• Kings Fund
Arm’s Length Bodies
• NHS England
• Monitor
• TDA
Sector
Representatives
• Hospitals Forum
• NHS Confed
• FTN Sector Experts
• KPMG
• McKinsey
• Reform
Public and Patients
What, Why, How

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1. What, Why, How
2. Typology of models
3. Emerging key themes

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Typology of models
Locality based
single or multi-
site trust
Federations
(e.g. UCL
Partners)
What models are we looking at?
Governance
Operations
SiteSite
Site
NHS Trust or FT
Provider Provider Provider Provider

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Typology of models
Service level
chain
(e.g.
Moorfields)
Joint venture
(e.g. GSTS
Pathology)
What models are we looking at?
Standalone
organisation
Standalone
organisation
Standalone organisation
Standalone organisation
expert or
specialist
provider
Service
Service
Service
Service
Partner
1
Partner
2
Joint
venture

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Typology of models
Management/
operational
franchise
(e.g. Circle –
H’brooke)
Geographically
disperse multi-
service chain
(e.g. BMI)
What models are we looking at?
Operational franchise Management contract
Board
Organisation
Board
Organisation
Group HQ
Outlet Outlet Outlet

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Typology of models
Vertically
integrated care
organisation
Do you have a good
example of one of these
models? Get in touch
with us at
daltonreview@dh.gsi.gov.uk
What models are we looking at?
Secondary -
elective
Secondary -
emergency
Community
Primary

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1. What, Why, How
2. Typology of models
3. Emerging key themes

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Emerging key themes
We are making use of three types of evidence
• Literature review
• Commissioned research
to inform the evidence
base
Desk-based Research Engagement Qualitative Case Studies
• Sector stakeholder
events throughout May
to September
• Workshops and round
tables to test emerging
policy findings
• Public – ideas and
comments
• Call for evidence across
the sector
• Interview with a range
of system leaders who
have experience of each
model
• National and
international visits to
examine the detail of
each model – barriers/
incentives
• Case studies to inform
the final report
We will triangulate these evidence sources to provide robust findings and conclusions.

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Emerging key themes
Why consider Organisational form?
• Unrealised potential in the health sector
• Struggling providers
• Learning from approaches internationally
• Learning from other sectors

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Emerging key themes
Emerging themes
• Leadership and management
• Ownership and governance
• Policy, legal and regulatory barriers
• Culture and values
• Infrastructure and assets
• Efficiency, costs and savings

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Questions
Questions or contributions?
Thank you for listening
Questions, contributions?

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Contact details
Get involved
#DaltonReview2014