Three of England’s most well respected foundation trusts are working on a partnership through which they can lay the groundwork to build and run hospital chains, HSJ has learned.

  • Northumbria Healthcare, the Royal Free London and Salford Royal working on partnership which could lead to hospital chains
  • “Enterprise” is not intended to establish chain between the three trusts, but a vehicle to share expertise
  • Follows Dalton review recommendation to set up NHS hospital chains

The FTs involved are Northumbria Healthcare, the Royal Free London and Salford Royal.

It was the latter trust’s chief executive, Sir David Dalton, who last year penned a government backed review endorsing the establishment of hospital chains – or “foundation groups” – in the NHS.

The partnership, which HSJ understands has been tentatively called “Enterprise”, is not intended to establish a foundation group or any kind of chain arrangement between the three organisations.

Sir David Dalton

Sir David Dalton says ‘standard operating models’ by high performing FTs are the first step to establishing hospital chains

It is instead expected to be a vehicle through which they can share intellectual property and use their combined scale to determine best practices for areas from operational management to clinical pathways.

The idea is that this knowledge can then be codified in a “standard operating model” – a detailed set of rules through which the founder trusts can standardise practices to ensure high quality, efficient care.

This model could then be used by any or all of the three FTs to develop their own foundation groups. Any hospital trust joining one of these groups would have to adopt the standard operating model. In this way it is believed these successful organisations can spread their success across wider geographies.

HSJ understands that the three FTs would likely only be interested in forming groups with trusts that voluntarily wanted to join them.

The FTs have applied for their project to be included in NHS England’s “vanguard” for future models of acute care, a process which is partly a response to the Dalton review.  

A copy of their vanguard bid, seen by HSJ, said: “The tolerance of variation in our NHS is the biggest challenge which prevents us from assuring reliable service standards and improved productivity. 

“Over the next five years NHS providers must be more adept at standardisation and reliable implementation. Two-hundred-and-forty (the number of trusts) separate approaches are not providing the public with high standards of care, nor the taxpayer with value for money – change must happen and it must be organised to happen at scale.

“Horizontal integration across organisations enables scale to be achieved and it must be pursued in addition to local vertical integration between primary and secondary care.”

The document emphasised that the partnership is “not designed in itself to act as a ‘group’ to deliver patient services through common/shared governance”. It said the trusts will instead work jointly on “opportunities and challenges to create reliable and innovative solutions that can scale across the health and care industry”.

The Dalton review suggested that the development of “standard operating models” by high performing FTs was an essential first step to the establishment of hospital chains in the NHS, and the means by which these chains could be successful where many traditional NHS mergers and acquisitions have failed.

The review concluded that European hospital chains had reaped financial and clinical benefits from standardised procurement and clinical pathways, and shared back offices by bringing every hospital they acquired into their standard operating models.

NHS England is expected to announce the trusts that will be in its “acute care collaboration vanguard” next month. This vanguard process came after NHS Five Year Forward View pledged to promote both hospital chains and Moorfields style single service chains, in response to Sir David’s recommendations.

Since the general election, there has been increased interest in the concept of NHS hospital chains among senior figures in Westminster and Whitehall. In recent board papers for Cambridge University Hospitals FT, chief executive Keith McNeil described how he and five other provider chiefs attended a meeting at 10 Downing Street on the subject of chains.

He said others in attendance included NHS England chief executive Simon Stevens, the prime minister’s health adviser Nick Seddon, cabinet secretary Sir Jeremy Heywood, civil service chief executive John Manzoni, and health minister Lord Prior.

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