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

And the winners are…

Each year since 2014, HSJ has assembled a group of the good and the great and asked them to determine the NHS’ 50 best provider chief executives.

When the analysis started, the list was dominated by older men running England’s most prestigious teaching trusts. Six years later, the picture looks very different.

The grand old men whose personal brand was as high-profile as the giant organisations they ran have (mostly) gone. In their place have come more women and younger men, many of them running mental health or smaller acute trusts. Most have a low key management style.

The 2014 list had 10 women; the 2019 one has 24. Dame Marianne Griffiths – who has worked wonders at Brighton and Sussex University Hospital Trust – takes first place for the second year running. Dr Navina Evans from East London Foundation Trust is again the runner up.

West Suffolk’s Steve Dunn – a reformed system manager – continues his dizzying rise to take third place.

The judges – including Care Quality Commission chief inspector of hospitals Ted Baker and NHS England and Improvement director of emergency and elective care Dame Pauline Philip – considered many factors while making their deliberations.

But the most powerful influence appeared to be the staff survey results, trumping even CQC ratings. An analysis of the results by Listening into Action shows around half of the top 50 had positive staff survey results which were getting better, while only just over 10 per cent had negative scores that were getting worse.

Of course, NHS England/Improvement is looking for a chief operating officer. HSJ hopes – and believes – the sixth HSJ Top 50 chief executives will help inform that appointment.

Joining the digital dots

The push to join up patient information digitally has taken another step forward with the signing of a £12m contract to build a single regional record in Thames Valley and Surrey.

The contract is important for several reasons.

Thames Valley and Surrey was one of five “local health and care record exemplars” picked by NHS England to create a single shared digital record by the end of 2020, each covering millions of patients.

These regional records, or “LCHREs”, are a key element of creating integrated care systems, providing detailed information to support direct care and planning across organisational boundaries. The long-term plan states these regional records will cover the country by 2024.

Thames Valley and Surrey is first of these LCHRs to sign a major contract, with IT supplier Graphnet, to build an entirely new record (although, technically Frimley Health FT signed the contract on behalf of the group).

While some LCHREs will cover more people once built (One London will cover 8 million), they have either not gone to market or are planning to string together smaller existing records. When finished, the Thames Valley and Surrey record will cover 3.8 million people, making it bigger than anything currently running in the NHS.

The record will cover a vast and messy landscape over three sustainability and transformation partnerships, five integrated care systems, more than a dozen trusts and hundreds of GP practices, and three existing smaller regional records.

These organisations have already collectively agreed to help fund the record for seven years – a small miracle all of its own – and support the concept in principle. But they have not yet agreed to contribute patient data to the record – a common and often fatal stumbling for shared records – and the biggest risk to LCHRE programmes overall.

Success is far from guaranteed, but Thames Valley and Surrey is better placed than most to scale up a regional record. It has a high concentration of digitally advanced trusts and ICS, some of which are already running their own smaller region records.

If successful, it could prove a model for other regions to follow.