STP and ICS leadership: High turnover sees shift away from job shares

In spring 2016, when sustainability and transformation plan leads were first chosen, 16 were current chiefs or chairs of acute or acute and community trusts – there are now six.

Since then, some have retired from the acute role but stayed with the STP – such as Sir Andrew Cash in South Yorkshire and Bassetlaw and Alan Foster in Cumbria and the North East – while others have been replaced by clinical commissioning group chiefs, executive leads dedicated to the STP or integrated care system, or others (such as Sir David Sloman in north central London and Nick Hulme in Suffolk and North East Essex).

Including mental health trust chiefs (there are no community-only trust or ambulance trust leaders in the roles) as well as acute, the number has gone from 19 to 11.

HSJ has also found from an analysis of changes in STP and ICS leadership:

• High turnover, with 29 of the 42 current systems (70 per cent) having had at least two executive leads since 2016, and a fifth having had at least three. In 13 systems (31 per cent), there have been at least two executive leaders since summer last year. Turnover appears to be higher than among trust chief executives, where average turnover has been found to be around three years, and less than half changed in a three-year period.
• Nine systems – just over one in five of the 42 – have a councillor or council official in either or both of their lead executive and non-executive posts.
• Thirty STPs and ICSs (71 per cent) have some form of non-executive chair in place – most of whose posts have been created over the past year.
• Thirty-two (just over three-quarters) were able to identify a clinical lead; 37 (88%) were able to identify a finance lead; and 36 (86 per cent) had a programme director or managing director post.

Job shares slide

The table shows the share of STP executive leads who hold joint leadership roles, by type of organisation, and the share doing the role in a dedicated capacity (with no dual role):

Turnover

STPs have seen their executive leaders replaced for various reasons, including retirement and job moves, as well as decisions that the arrangements weren’t working. Some systems with complex challenges have seen lots of change: Devon has seen financial and performance problems over recent years, while Norfolk still has several trusts rated “inadequate” by the Care Quality Commission, and Sussex and East Surrey also had major financial problems. In some cases new dedicated executive leaders have been brought in to the patch to try to address problems and disagreements.

Devon STP has seen the most changes, including the appointment of Philippa Slinger, a former trust chief executive and NHS England/Improvement improvement director in Norfolk, who joined at the beginning of last month (July).

She said in a statement: “The Devon system has had a number of changes to its leadership over the last three years which inevitably will have had some impact on the pace of progress. However, the NHS and local authority CEO community in Devon as a whole has been relatively stable and is working hard to deliver improved services for local people.

“Following a recent review, we are focussed on further developing the way we work together to deliver consistent and strong leadership across our system. This, combined with a shared commitment to work in partnership, will be key to creating a successful STP and ICS.”

NHS England said: “Appointments are rightly local decisions, but to help ensure the successful delivery of the NHS long-term plan in every local system we are committed to widening the leadership capabilities at every level, with a £2m programme to help 23 areas kick-start or boost leadership development and national networks sharing best practice and supporting change.”