Form follows function: Governance challenges for providers in light of the Dalton review


30 / 03 / 2015

This joint NHS Providers and NHS Confederation report explores the governance implications of the different organisational forms proposed in Sir David Dalton’s review of organisational forms, published in December 2014.

Any change in organisational structure arises from a strong business case to develop models of care for patient benefit (to improve outcomes, safety or experience), and/or to deliver a more efficient service, providing best value for the taxpayer and potentially releasing funds to reinvest in patient care.

While many of the organisational forms proposed in the Dalton review (such as joint ventures and federations for example) have been explored by a
number of providers, the concept of a management chain or group structure remains unfamiliar in the English NHS. 

Crucially, there is limited guidance available about how NHS providers can put in place robust governance structures and local accountabilities to help ensure the benefits articulated in the business case are realised in practice.

This publication:

  • focuses on good governance from the outset as a critical factor in determining the success of any ‘delivery vehicle’
  • reviews the importance of board assurance on the rationale for change, to ensure that form genuinely follows function
  • explores the governance implications of adopting different organisational forms for the purposes of improving quality and/or efficiency, and provides some core questions for provider boards to use to inform their thinking
  • signposts the information and support already available, including a series of practical checklists on each organisational form which were published by the Department of Health (DH) alongside the Dalton review.

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