New approaches are needed to support multi-site working says Dalton Review

Man looking at blackboard with arrows pointing mainly in one direction

This review is particularly timely because it focuses on the options and opportunities for collaborative working between providers delivering health and social care to the general public in England.

The restructures and mergers that have been taking place over the past few years, are a result of the Department of Health’s commitment to improving care by:

  • operating more efficiently
  • reducing wastage and duplication
  • working with other sectors, such as social care and local authorities
  • reducing variation of care across the country

The review supports the NHS England Five Year Forward View, which explains the changes that need to be made and how important it is that the NHS works with other organisations to take them forward and improve care delivery. However, with these changes, it is important to recognise that new approaches to leadership and operating might be required, in response to the different experiences and ways of working that each collaborating organisation might have.

Keyboard and musical notes

Five key themes are discussed in this review


Five key themes are discussed in this review

  1. One size does not fit all
  2. Change needs to be implemented more quickly
  3. Successful organisations should be “encouraged to spread their reach
  4. Sustainability for providers is essential
  5. A dedicated implementation programme needs to be in place

The review is made up of three chapters:

  1. Organisational forms
  2. Making change easier and quicker
  3. How to make change happen
Block men each standing in a separate box

New approaches to leadership and operating might be required to reflect the multi-site operations

Organisational forms

It is vital that leaders understand that “one size does not fit all”, when it comes to implementing an appropriate organisational form. For example, local authorities will have different approaches to serving the public, and health service delivery could be improved by adapting practice and adopting other ways of working. Different organisational forms, such as joint ventures, consolidation, integrated care organisations, and multi-site trusts are described in great detail, alongside brief case studies and illustrations, However, the review does not just focus on formal structures, but also informal ones, such as:

  • Buddying
  • Informal partnering
  • Clinical and strategic networks
  • Mutual or social enterprise

The review stresses that “there are no ‘right’ or ‘wrong’ organisational forms”, but they must suit local, rather than central, needs.

Lots of hands holding together in the middle of a circle

There are both formal and informal ways to collaborate


The reason this document focuses on providers is because they are what the general public see as ‘the NHS’, and who the public feels are responsible for variations in service delivery.

In the Executive Summary, each of the five themes described above, is accompanied by a brief description, together with the body/ies which are responsible for leading on the themes, and a set of recommendations for them to apply. As commissioners, you should particularly focus on themes 2 and 3, as these make specific recommendations for Clinical Commissioning Groups, looking at which models you want to support, and how you will allocate resources for quick service transformation. It also provides a list of “credentialed organisations” to help you choose the best partner organisations to suit you.

There are a couple of accompanying reports which support this review, and the links for these are below. It is important for you to understand the context behind this review, as it will help improve the collaborations that we build and the services we deliver to the general public.


Dalton D. Examining new options and opportunities for providers of NHS care: The Dalton review. Department of Health, December 2014

Related content

Crump H, Edwards N. Provider chains: lessons from other sectors: A report for the Dalton review into new options for providers of NHS care (PDF). Nuffield Trust, December 2014

NHS England. Five year forward view (PDF). NHS England, October 2014

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Caroline De Brún

Caroline De Brún

Caroline has been a medical librarian in a variety of NHS and academic roles since 1999, working in academic, primary and secondary care settings, service improvement, knowledge management, and on several high profile national projects. She has a PhD in Computing and currently develops resources to support evidence-based cost and quality, including QIPP @lert, a blog highlighting key reports from health care and other sectors related to service improvement and QIPP (Quality, Innovation, Productivity, Prevention). She also delivers training and resources to support evidence identification and appraisal for cost, quality, service improvement, and leadership. She is co-author of the Searching Skills Toolkit, which aims to support health professionals' searching for best quality clinical and non-clinical evidence. Her research interests are health management, commissioning, public health, consumer health information literacy, and knowledge management. She currently works as a Knowledge and Evidence Specialist for Public Health England, and works on the Commissioning Elf in her spare time.

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