Dame Julie Moore is to become the most powerful provider chief in the NHS. She will need time to make real changes.

Merging hospital trusts has rightly become discredited as an easy fix to solving their clinical or financial shortcomings. However, it leaves the health service in need of alternative solutions for the many trusts whose numbers don’t add up, as well as its shortage of chief executives and the need for health economies to come together.

Hiring Dame Julie Moore as chief executive of troubled Heart of England Foundation Trust, while she retains the same role at University Hospitals Birmingham, is a sensible workaround in tough circumstances. She, and her chair Jacqui Smith, who is also joining HEFT, run an extremely tight ship at UHB, and its neighbour is in urgent need of a strong new chair and chief.

Bringing in an expensive interim from outside is difficult to justify on cost and value grounds, and this arrangement delivers high calibre leadership with much less fuss than alternatives like full merger or management franchise.

£1.4bn turnover

The result is that outspoken and high profile Dame Julie will control five hospitals with a combined turnover of £1.4bn, making her the
most powerful provider chief executive in the NHS. A coincidental but important consequence is that the two trust chief executives with the largest domains by income will both be women. Alwen Williams was confirmed as permanent chief of Barts Health this month.

‘While the move is a neat one for Birmingham, there are also clear risks’

While the move is a neat one for Birmingham, there are also clear risks. It has avoided creating a vacancy at the top of UHB, but Dame Julie will not be spending much time there in the immediate future - UHB’s senior team will have to fill her formidable shoes.

Dilution of senior capacity at top providers will be a common challenge if and when they reach out to help struggling trusts, for example as hospital chains take off. Another potential risk lies in the consolidation of power. Simon Stevens this month described the importance of local leaders coming together to form “nascent health systems”.

Dominant figure

Birmingham’s dominant healthcare figure is now, indisputably, its acute sector boss. A test of the new arrangement will be whether GPs, those in community and mental health services, and commissioners are given a meaningful say in what happens in the city.

Given the NHS has fewer successful leaders than leadership roles, will the approach taken in Birmingham, or variations on it, be
taken elsewhere? One place to watch is Sherwood Hospitals FT. Monitor and the Care Quality Commission have agreed that the FT needs a “close tie up with a strategic partner” - but have not explained what this means.

An attractive aspect of the Birmingham solution is that, unlike a conventional takeover, the plan has been implemented without having been pondered by the Competition and Markets Authority. Formal involvement of the CMA takes months, and Heart of England would have declined further during the limbo period. Instead, Monitor is now keeping the CMA briefed informally.

This will, hopefully, mean expected benefits for patients are properly weighed up before the commercial regulator makes any intervention.

‘Good organisations are not forged from leadership churn, and uncertainty damages staff morale’

Monitor may have achieved this - and in doing so potentially established a helpful precedent - by stating that Dame Julie’s position at HEFT is “interim” only, even though there is no end date in clear sight.

However, she will need time to dig in and make changes at the trust, probably in the face of some internal opposition. Its finances, governance and culture all need fixing. There is also a chance to consider afresh the configuration of hospital services as a whole across Birmingham.

Good organisations are not forged from leadership churn, and uncertainty damages staff morale.

For these reasons, Dame Julie should be given years, rather than months, to complete her work at HEFT.