The must-read stories and debate in health policy and leadership.

A sharp increase in the number of trusts which now share a chair or chief executive has been illustrated by an exclusive HSJ analysis.  

Our analysis, published on Monday with an interactive map showing the arrangements for every trust, reveals more than a third of trusts now share a chair or CEO, or will be moving to this sort of model soon.

It means that of the 211 separate NHS provider boards, there are now just 154 different chairs, and 178 CEOs.

There are different reasons behind these decisions, and in some cases the arrangement is not permanent. In some trusts, the arrangement has led to the formation of “group” models.

Nuffield Trust CEO Thea Stein, a trust boss herself until last year, warned that shared leadership was not the “magic bullet” it was often viewed as.

“In reality, it must always be guided by clarity about what outcomes you are seeking to achieve and why the shared leadership is the part of the solution. Ideally these outcomes should be about better patient care and staff experience,” she said.

Very little published national policy exists around shared leadership, but HSJ understands some may be released in the forthcoming year.

All change

Tracy Bullock leaving University Hospital of North Midlands Trust marks the first chief executive departure in acute-land this year.

Putting in an impressive five-year shift at an organisation that had performance issues before it was born (UHNM was created in 2014 from the old Mid Staffordshire Foundation Trust and the neighbouring North Staffordshire Trust), Ms Bullock is taking ill-health retirement. We wish her well.

Previously leader of Mid Cheshire Hospitals FT, in June she will leave a provider landscape significantly different from the one she encountered when first taking a chief exec job in 2010.

Back then there were roughly 50 per cent more hospital trusts than there are now. Hinchingbrooke Healthcare Trust was the smallest in the country (now part of North West Anglia FT) – if we exclude “The Min”, the Royal National Hospital for Rheumatic Diseases, a specialist.

The past 13 years have seen a steady march of mergers and acquisitions, removing full boards from largely smaller organisations and making them part of giant provider agglomerations.

Did the Mid Staffs scandal damage the idea that you could leave them to manage themselves?

Did the Lansley era convince people that actually you weren’t ever going to create an archipelago of competing, university-style, self-funding institutions?

Was it just to save money and make for more direct lines of accountability to the centre?

It’s never been openly discussed but HSJ research recently demonstrated a third of NHS trusts now share a chief executive and/or chair.

Also on today

In West Country Chronicle, Nick Carding weighs up 2024’s chances of being better than 2023 – not to mention the annus horribilis of 2022 – and in Comment, Tom Roques says the new health secretary must commit to sustained action, clear funding and strategic technology integration to make lasting improvements in cancer care.