London Eye: From shared chair to where?

A year ago, most of the capital’s trusts had a shared chair. As of tomorrow’s meeting of the Barts Health Trust board, about half of the biggest trusts in London won’t.

After King’s College Hospital Foundation Trust was returned to financial special measures, shortly after leaving it, the finance director left and it was decided that chairing KCH and Guy’s and St Thomas’ was too much work for anyone except Sir Hugh Taylor.

(When Wes Streeting’s teams are looking over the map of financially challenged trusts and deciding where to visit, they should know that understanding KCH’s finances would tax Tolstoy, let alone lesser mortals. However, if they got beneath the skin of the relationship between Denmark Hill and the various central bodies that largely decide its financial fate, there might be some important insights).

And, as some well-placed sources describe it, Sir Hugh privately viewed his King’s duties as a bolt-on to the GSTT job, whatever he had to say in public.

So with the news this week that Jacqui Smith is not chairing tomorrow’s meeting of the Barts’ board, and is instead taking up a ministerial role in education with the new government, is the tide turning on shared chairs?

The former Labour home secretary and lockdown-era Strictly Come Dancing star also chaired Barking, Havering and Redbridge University Hospitals Trust. The two trusts covered all but one borough of east London and commanded a turnover of approximately £3bn.

This move, like all shared chair arrangements in London, was a product of the David Sloman leadership era in the capital, in which to centralise power he appointed as many shared chairs as possible across trusts.

Cash-constrained, covid-battered – perhaps that was reasonable at the time. But is it now?

There are lots of factors to making a high-performing organisation. Having an independent chair might be a small one. It might be a large one. No one really knows. But the lesson of the Mid Staffs Inquiry wasn’t: less leadership accountability at a local level makes services better.

So will Barts and BHRUT get separate chairs or another shared arrangement? At the moment the vice-chairs at each organisation are standing in for Ms Smith (whose media career made her easier to target by unions, one of the unions said recently).

If the centre still has a grand vision of every ICB having only one hospital provider and one community/mental health provider per ICB then maybe it makes sense to wait until the term of Homerton University Hospital FT’s chair is up in a year.

The acute provider collaborative across this patch has retreated from the idea of a shared executive team across the trusts.

Homerton has always performed well anyway, and what if the upheaval had tanked the recent, very heartening improvements at BHRUT?

It is by no means clear the shared chair era is over, but in London at least it might be in abeyance.

Now Mr Streeting, a word about those hospital rebuilds in London… (the undisputed capital of backlog maintenance deficits).