Reading much of the media coverage on David Dalton’s review, full of phrases like ‘hospital chains’ and ‘super heads’, you could be forgiven for thinking that only leaders in the acute sector have the know-how to tackle the challenges providers across the system face.
In reality, nothing could be further from the truth.
Struggling trusts usually face longstanding challenges that are really about the sustainability of their local health and social care economy as a whole. They can’t turn their situation around by working in isolation.
So, while the concept of making the support, learning and expertise already present in the NHS more available to challenged organisations has to be right, we should be pragmatic about how this is done. The expected benefits of mergers often fail to materialise. A historic local budget deficit can’t be tackled just by parachuting in a new senior management team to one provider, or making them part of a ‘hospital chain’. Instead, supporting challenged trusts to develop new kinds of partnership could make the crucial difference.
The way forward for many local health and care economies is to reshape care to work more effectively and sustainably for the growing number of people with ongoing, complex needs. These needs will best be met through more community health and social care, delivered by multiple organisations working collaboratively. Each area has different circumstances and will have to form very different kinds of partnerships.
Some partnerships will be relatively small scale, to reshape individual services. Others may be far larger, with community-based providers (whether community or mental health providers, or GPs as providers) well placed to lead collaborative management of the whole capitated spend in local systems.
Community and mental health leaders have real expertise in the kind of partnership working struggling trusts will need. Operating in a highly commercial sector, we are used to tendering for contracts and building partnerships with multiple organisations (including voluntary and private sector) to develop a strong, innovative and sustainable offer. The learning from these kind of experiences has great value for the rest of the NHS.
The wealth of examples includes:
- Lincolnshire’s Prevention and Avoidance Community Team, a partnership between the NHS, third sector and a housing association, to get vulnerable adults back home from hospital as quickly and safely as possible.
- The partnership between Sussex Community NHS Trust and Capita, to identify efficiencies and improve services and processes.
- The seven different commissioners and providers working together to develop Queen Mary’s Hospital into a community-facing hospital.
What should all this mean for the Dalton review?
Firstly, if partnership working is key to preventing failure, we must ensure struggling providers can learn from successful partnership working and access peer support to develop their own partnerships in the most challenging circumstances.
Secondly, we must look to the whole
system – including community providers – for learning, solutions and support. Focusing only on acute trusts will not work.
Recent developments are encouraging.
Rob Webster, NHS Confederation chief executive and Stephen Dalton (no relation to David!), Mental Health Network chief executive, have been asked to join the review panel to help bring a wider, whole-system perspective. I was pleased to be part of a group of chief executives of community and mental health providers who recently shared with Jeremy Hunt, Norman Lamb and officials supporting the Dalton review our thinking on the support organisations like ours could offer others in the NHS.
David and his team will find many other leaders outside the acute sector who are ready and willing to offer their support to failing providers.
To enable this, a few practical things would help, including:
- making sure the best trusts from anywhere in the system can be ‘credentialed’ to provide support
- looking at incentives for joint working and ways to create enough stability to enter into partnerships for many years – including longer-term contracts
- finding ways to grant more flexibility and freedom for NHS trusts to adopt different models, structures and partnerships.
My challenge to the Dalton review panel is this: will you help the whole NHS get full value from the learning, solutions and support community services bring?
Matthew Winn is the new chair of the NHS Confederation’s Community Health Services Forum and chief executive of Cambridgeshire Community Services NHS Trust. Follow him on Twitter @WinnMatthew