The creation of new organisational models should be driven by providers rather than the government “dictating” change from the centre, according to Sir David Dalton, who is leading a review into possible hospital reforms.
In a letter to the health secretary Jeremy Hunt giving an update on the review’s progress, Sir David said that “the adoption and development of new organisational models is for the sector to drive, not the centre”.
He added: “The role of the centre is to create a more permissive environment, removing barriers and enabling – but not dictating – change”.
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The review aims to offer “the vision and tools” for providers to adopt new models to improve outcomes for patients.
According to Sir David there are currently “too few incentives” to encourage NHS leaders to move from “just being stewards of their organisations to becoming strategic architects of their system”.
Provider reform is hampered by “the uncertainty of the legal framework they operate in, and a lack of clarity regarding what is or is not possible under the current system”, Sir David said. He wishes to remove “perceived and actual barriers to change”.
Organisational change is “perceived as overly complicated, costly and confusing” and providers have “tended to maintain the status quo or default to mergers as their preferred solutions”, he wrote.
Offering alternatives and incentives to providers could “inject some much needed pace for quality improvement into the system”.
The “early successes and limitations” of the current buddying arrangements that were set up following the Keogh review could provide a lesson in developing future provider models and the review team are “particularly keen to find early adopters and enthusiasts for change”.
The review aims to encourage hospitals “that do well to do more” while “empowering” struggling providers.
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