• Just two systems either do not have a chair in place or are not actively recruiting one
  • Net increase of 12 chairs since July 2019
  • Diversity among system chairs and leaders remains very poor, with just three people from a BME background

Almost every health system now has an independent chair in place or are actively recruiting to the post, HSJ analysis shows.

Forty of the 42 sustainability and transformation partnership and integrated care systems have either already recruited an independent chair, or are in the process of doing so.

This represents a net increase of 12 since July 2019, when HSJ last analysed STP/ICS leadership and there were 30 independent chairs. It could also be a sign that the governance of these systems is beginning to bed in.

Only two systems do not have a chair in place and are not actively recruiting for one, despite NHS England’s implementation plan making an independent chair an expectation of a “mature ICS”. They are Lincolnshire STP and South Yorkshire and Bassetlaw ICS.

A spokesman for South Yorkshire and Bassetlaw ICS said: “We have an equivalent role in that [Sir] Andrew Cash is part-time and is independent of any organisation. He chairs our partnership board.” Sir Andrew’s job title is the South Yorkshire and Bassetlaw ICS lead.

A spokeswoman for Lincolnshire said: “The STP’s progress and activity is reported through our Lincolnshire coordinating board upon which sits the chairs and CEOs of all providers and commissioners, as well as representation from other partners. The [board] is chaired by an elected member of the group.”

Three systems out of 42 are currently recruiting to the role of chair; Bedfordshire, Luton and Milton Keynes ICS; Dorset ICS; and Lancashire and South Cumbria ICS.

There are now three chairs from a black and minority ethnic background, an increase from one since last summer, in South West London, North East London and the Isle of Wight. Three quarters of the roles are filled by men.

System leaders

Analysis of other leadership roles has found some limited evidence that leadership across STPs/ICS is also bedding in. There has been a small increase in systems being led by the same leader compared to July 2019.

But some systems also appear to be moving away from having a named clinical and financial director in favour of this role being performed by multiple directors. In finance, the number of systems that have a named financial director dropped from 37 in summer 2019 to 34 this January. Similarly, named clinical directors have dropped from 32 to 29 over the same period.

Across the board, the variety of leadership models remains roughly the same. For example, there are similar number of systems led by an accountable officer of a clinical commissioning group(s) or a trust chief executive.

There is a higher degree of gender equality among system leaders, but there are none from a BME background.