Health Foundation’s response to Sir David Dalton’s Review

Today (Friday 5 December 2014) sees the launch is the Dalton Review, the long anticipated review of NHS provider policy by Sir David Dalton, the Chief Executive of Salford Royal NHS Foundation Trust.

In reaction to this Dr Jennifer Dixon, Chief Executive of the Health Foundation, comments:

'The Dalton Review has one central message: give better performing trusts a bigger role in helping those performing less well and also in accelerating plans for new models of care, as outlined in the recent NHS Five Year Forward View.'

'That message is right. It is welcome that trusts who are performing well provide support for those that are not, whether through a peer to peer buddying role or more formal acquisition if appropriate. It may help the spread of good operational management, which must be central to good performance. Dalton’s suggestion is a sensible addition to the current ‘top-down’ approach when organisations are failing.'

'But two caveats. First the key lies in how strong performers are identified or ‘credentialled’. As Care Quality Commission (CQC) reports show, a trust performing well overall on current metrics is not likely to be performing well in every area. Also, it may not necessarily be skilled in the large-scale change needed to achieve new models of care. On the other hand, a poor performer may be well managed, but struggling because of a range of external factors such as weak primary care, patchy social care, historic funding under the needs based resource allocation target, or failure in a neighbouring trust leading to excessive demand on emergency care. These may be factors that a well performing trust has not had to face or are out of their control.'

'Second, buddying may be a stretch too far for trusts that are performing well, and lead to a dip (temporary or longer) in performance. The evidence on the impact of mergers, for example, is not very positive. Implementing Dalton’s suggestions will need very close monitoring, particularly in areas of quality not included on the usual dashboards.'

'Turning around performance needs skill, whether from within or without. Dalton rightly focuses on the need to build skills in management and leadership, helped by the NHS Leadership Academy. But quality improvement skills in frontline clinicians and managers  are equally critical, as Dalton knows from Salford Royal, where he is Chief Executive. How best to develop these skills across England, at pace, is now a very critical question for the NHS.'

Please note that Sir David Dalton is a Health Foundation Governor. 

Media contact

Mike Findlay, Media Manager
T: 020 7257 8047
E: mike.findlay@health.org.uk