One of England’s most influential NHS chief executives, University Hospitals Birmingham Foundation Trust’s Dame Julie Moore, has been appointed to simultaneously run its neighbouring acute trust. David Williams considers the implications.

Few would dispute Dame Julie’s ability to run an extremely tight ship, and few would doubt that Heart of England FT is in urgent need of strong leadership.

Dame Julie Moore

Hopefully Dame Julie Moore’s appointment will turn out to be more than an ‘interim’ measure, says David Williams

The reason given by the regulator Monitor for her appointment is to rapidly control and eliminate the huge unplanned deficit that has erupted at HEFT this year – both the size and unexpectedness of its £29.5m shortfall have caused alarm.

But there is plenty more that needs fixing at the FT: the trust has deep seated problems with governance and culture, and has long fallen short of key performance targets.

Bringing in Dame Julie to solve a financial crisis without addressing the way the trust runs would be a missed opportunity and a waste of her talents. However, truly solving HEFT’s problems will be a long term project.

What does ‘interim’ mean?

The official line is that the appointment of Dame Julie and UHB’s chair Jacqui Smith to HEFT is on a vaguely defined “interim” basis. Hopefully, it will turn out to be long term or permanent: good organisations are not forged from leadership churn and endless uncertainty, and the FT has not had a substantive chief for a year already. There would be little point bringing in a leader of Dame Julie’s calibre for few months to sort out the deficit, only to leave the trust with the risk of falling over again and with the task of finding someone else to fix its cultural problems.

Transforming the trust will not be a quick project. HEFT has had an excellent leader on a short term basis for most of this year in Andrew Foster, who runs a highly regarded FT and is famed for his skill in engaging staff. He will leave HEFT with his work unfinished, in part due to board level disagreements over his proposed programme of action. Dame Julie will need time to dig in and implement changes at the trust in the face of some likely internal opposition.

If bringing in UHB’s top leaders does turn out to be a long term measure, Dame Julie will be the undisputed strategic leader of hospital services for Birmingham. This is a different role to being chief executive of the biggest and best acute trust in the city, and it will be critical for the leadership to engage fully with the rest of the health economy. That includes primary care, in which former HEFT chief Mark Newbold is emerging as a major player in the city.

Strategic leadership

There is potentially a bigger prize than fixing internal dysfunction at HEFT. Much of Birmingham’s acute provision is now under the control of two chief executives: Dame Julie and Sarah-Jane Marsh, the Birmingham Children’s Hospital FT chief who recently took over the leadership of Birmingham Women’s Hospital FT. The women’s and children’s hospitals are both planning to rebuild, potentially adjacent to UHB. Dame Julie’s appointment raises the question – which has not previously been publicly mooted – of whether a bigger, city-wide acute reconfiguration may be possible.  

Why not just merge the trusts?

Mergers are out of fashion: only last week Simon Stevens decried their poor cost and delivery record. UHB and HEFT have a combined turnover of nearly £1.4bn. Bringing them together would be an enormous task, and could invite comparisons with the 2012 merger of Barts and the London, Newham University Hospital, and Whipps Cross University Hospital trusts, which has proved disastrous. HEFT itself is the unhappy result of a takeover of a “failing” trust by a successful one.

There is also the problem of competition. Economic regulator Monitor has not commented on how competition rules relate to the current situation, but a full merger would definitely have to be referred to the Competition and Markets Authority, holding up the process up for many months.

With increasing numbers of trusts struggling with performance, finance, or both, and many lacking a permanent chief executive, appointing interims in this way could become useful nationally as a practical workaround. It may bring the benefits of joint leadership, with minimal delay.

The result of the move in Birmingham is that the high profile, outspoken Dame Julie is an even more powerful and influential figure in the acute sector than she already was. But success is not assured: turning around a deeply troubled organisation will be difficult enough without simultaneously running one of England’s top teaching hospitals.

Exclusive: Julie Moore to run two Birmingham FTs