Weekly updates and essential insight into the NHS in the South West, by Will Hazell

More shared leadership in Bristol

In the previous Deep South I floated the prospect of a “South West super CCG”, as Bristol, North Somerset and South Gloucestershire clinical commissioning groups mull a merger.

If they don’t plump for that they will at the very least end up with a single accountable officer. When North Somerset and South Gloucestershire CCGs were placed in financial special measures in July, they were instructed to work with Bristol towards a “single commissioning leadership structure”.

It seems to be the view of the NHS arm’s length bodies that what’s good for the goose is good for the gander.

If NHS England is using special measures to shepherd the three CCGs together, a similar thing appears to be happening with NHS Improvement towards North Bristol Trust (in the provider version of financial special measures) and University Hospitals Bristol Foundation Trust.

On Monday, NHSI said that the sustainability and transformation planning process in Bristol “is indicating the benefits to service and financial sustainability of developing shared leadership arrangements across the acute providers”.

A statement from the trusts’ chief executives said they were “committed to pursuing the benefits of closer working” and “looking at options to consider formalising a closer collaboration that does not involve a merger”.

Exactly what form these arrangements will take – for example, whether they will involve the appointment of single chief executive and board – is not yet clear.

The trusts weighed up a merger a couple of years ago but ruled it out, partly because they estimated it would cost £30m.

Their decision to pursue “closer collaboration” short of a merger might also have been influenced by competition considerations.

While fostering competition has to all intents and purposes been ditched by the NHS’s national leaders, the architecture created by the Lansley reforms is still in place.

A series of service swaps between the two trusts in 2013 resulted in Monitor issuing a warning about a loss of competition, and the trusts are probably keen to avoid getting snaggled up with the Competition and Markets Authority and other assurance processes.

Shared leadership short of a merger is being pursued across the country, from Tyneside to Essex. With the Bristol tie-up, the model has finally arrived in the South West.

Gloucestershire in financial special measures

Gloucestershire Hospitals Foundation Trust has had quite a fall from grace.

A month ago it was officially predicting a £5.6m surplus for the year, but after a reassessment of its finances it emerged that it had a deficit of £11.1m at the end of August.

A review found the trust’s true financial position had been distorted by “changes to some key financial planning assumptions”.

On Monday, the fall reached what the trust’s leadership will be hoping is the nadir, with Gloucestershire being placed in financial special measures by NHSI for “very serious” financial governance failings.

In its statement the regulator said it would “work with the new CEO to correct those failings”. It might be a crumb of comfort to Deborah Lee – who joined in June and exposed the true financial picture – that she seems to have the confidence and support of the regulator.

New boss at Salisbury

Salisbury Foundation Trust is to get a new chief executive, with Cara Charles-Barks taking over from Peter Hill in January.

Mr Hill is retiring, having joined the hospital as a charge nurse 30 years ago and worked all the way up to chief executive in 2013.

Ms Cara-Barks moves to Salisbury from Hinchingbrooke Health Care Trust, though she qualified as a nurse and gained much of her management experience in Australia.

The South West is acquiring quite a pool of Antipodean experience.

Kathy Byrne has been chief executive of Royal Cornwall Hospitals Trust since April, while Julie Hartley-Jones, who is due to take over at the Royal Devon and Exeter FT in January, has been working Down Under for the last decade.

With the Australian healthcare system significantly more integrated than the NHS, some of that experience could come in handy.

Deep South

Deep South is HSJ’s email briefing on the NHS in the South West of England.

It takes an in-depth weekly look at a region which is one of the NHS’s most innovative, but also one of its most turbulent. The patch includes the cities of Bristol and Bath, through Wessex and Dorset, and all the way down the peninsular to Lizard Point.

Please get in touch with any suggestions about what you’d like to see covered and any story tips: will.hazell@emap.com