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Trusts across the capital have been gradually agglomerating since before the pandemic, with the sharing of board chairs as the most visible sign that providers are coming together.

The latest announcement that trusts will share a chair came last week when The Hillingdon Hospitals Foundation Trust, London North West University Healthcare Trust, Imperial College Healthcare Trust, and Chelsea and Westminster FT announced the four of them would split the role.

To our knowledge, this is the first time trusts have looked to appoint a four-way joint chair. Two has been the norm, maybe three.

On the face of it, four boards splitting a chair seems excessive. Can one person give sufficient focus and attention to the divergent trusts in NWL, with its two large, august, historically independent-minded inner city teaching trusts and the two outer London providers that have struggled on quality and performance.

But it is actually the latest step in a long process of drawing the four acutes into a single provider collaborative. Chairing four separate trusts would probably be too much for one person but a paper presented to CWFT’s board of governors this month shows that the structures underneath the chair are set to change, too.

The boards will gradually form committees-in-common with delegated decision making for finance, quality and performance. There will also be changes to executive teams, with the health system leaders saying they will, “over time, need to consider how to align executive function with the collaborative”.

There is, of course, still the potential for this shared chair to collapse under the weight of the four trusts relying on them but it won’t be for lack of effort in reorganising the structures underneath them.

New faces, old problems

A fourth leadership team in five years will try to steady the ship in what has been one of the rockiest integration journeys.

A message to staff at Cheshire and Merseyside ICS announced Sheena Cumiskey as the system’s new chief officer, but only for a three-month period while attempts are made to permanently recruit to the role.

Ms Cumiskey will not apply for the permanent position, instead saying she will definitely return to her post as Cheshire and Wirral Partnership Foundation Trust chief executive in the autumn.

Earlier this year, ICS chair Alan Yates and chief officer Jackie Bene announced they were quitting because the roles had become “something they didn’t sign up for”. They had also faced difficulties in managing local relationships.

As revealed last week, a subsequent recruitment process for a new permanent chair failed to appoint anyone, which resulted in David Flory being brought in as interim chair. He also chairs the Lancashire and South Cumbria ICS.

Mr Flory and Ms Cumiskey will be the system’s fourth leadership team since 2016, and have a daunting job on their hands to start forging some ICS structures which the NHS and local government can both agree upon.