Provider chains: lessons from other sectors

Review of NHS providers' potential to develop different organisational forms


Published: 05/12/2014

Download the report [PDF 784.2KB]

The Nuffield Trust was asked to contribute to Sir David Dalton’s review into new organisational options for providers of NHS care. 'Provider chains: lessons from other sectors' distils learning from companies operating chains outside the NHS, and reviews the historic NHS experience of operating multi-site organisations. 

Structural change involving NHS trusts has, so far, mostly been a result of mergers and acquisitions. The newly formed organisations usually operate within fairly traditional organisational structures, even where there is an element of working across multiple sites. 

Sir David’s review looked at ways to use structural change to do much more: allowing NHS trusts to make care available to a wider population than they can do using their usual local, often single-site focused model.

The Nuffield Trust interviewed senior leaders of non-NHS multi-site organisations, including legal chains and nurseries, to produce a set of lessons on what makes a successful chain. We then tested those lessons with NHS leaders, to see whether and how they might work in the health service.

Based on these steps, we draw out a set of lessons to offer NHS providers seeking to disperse high-quality operating practice more widely, and to avoid some of the pitfalls that previous attempts at structural change in the NHS have encountered.

We conclude that multi-site chains will need to work differently from merged organisations in the past. Rather than one organisation taking over another and running it using its existing management, there needs to be a separate corporate core that oversees the different sites.

The report was written by Fellow in Health Policy at the Nuffield Trust, Helen Crump. Commenting on the research, Helen said: "One of the most striking findings of our research was the extent to which the leaders we interviewed felt that they were in control of their organisations’ destinies when making decisions about future plans."

Suggested citation

Crump H and Edwards N (2014) Provider chains: lessons from other sectors. Nuffield Trust.