Essential insight into England’s biggest health economy, by Ben Clover.

Last week was a busy one for joint appointments at the top of London trusts.

So much so that it is now easier to compile a list of non-foundation trust that don’t have some form of shared leadership, chair or chief executive, planned with another trust.

As previously reported, one of Sir David Sloman’s aims as regional director was to reduce the number of potential barriers to service change in the capital – for example, awkward chairs.

A quick survey shows there aren’t actually many non-FTs left to go.

To start at 12 o’clock on London’s clockface, Whittington Health Trust’s interim chair is due to stand down next month.

It would be surprising if the next substantive holder of this post was not already chairing an organisation in north central London – the obvious candidates being the incumbents at the Royal Free or UCLH. The Royal Free was one of the hospital chain pioneers, while UCLH has already started to integrate some services with their smaller neighbour.

At North Middlesex University Hospital, interim chair Peter Carter is due to stand down at the end of October or on the appointment of a new chair. A previous chair of the trust fairly publically rebuffed closer working with the Royal Free hospital group, so who gets appointed here is likely to be significant.

NCL’s two main mental health trusts, Camden & Islington FT and Barnet, Enfield and Haringey MH Trust announced a vague-but-perhaps-one-day-consequential move towards joint working in April.

Barts Health Trust is already its own hospital group and the Homerton a high-performing FT. Further east, HSJ last week reported the hospital trusts serving Barking, Havering and Redbridge and North East London FT were looking to appoint a joint CE to complement their already shared chair.

In south east London, Lewisham and Greenwich is the only non-foundation trust left.

It is not clear how much of Val Davison’s term remains, but she was appointed in June 2017. Even if she were due to end her term soon, a joint post with another trust would only really make sense with Oxleas Foundation Trust.

If it allowed closer working with the mental health provider in the outer south east London boroughs, it might go someway to better integrating the community services Oxleas runs in Greenwich with Lewisham and Greenwich Trust’s hospital in Woolwich. LGT already runs community services in Lewisham. Plus every emergency department would welcome better coordination with their mental health provider, whose patients often wait longest in the ED.

Oxleas’ chair Andy Trotter was appointed in 2015.

In south central London, the shared chair/semi-secret merger plan at King’s College Hospital and Guy’s and St Thomas’ has been discussed here previously.

More recently, the work towards integrating South London and Maudsley Foundation Trust and South West London and St George’s Mental Health Trust could well involve a shared chief executive before too long (although Deloitte is still working through the options).

David Bradley, SLaM’s new chief, was recently in charge of SWLSTG. But the two organisations are not alike in esteem – self and otherwise – so it’s worth thinking about whether such a move would be popular in SLaM and whether it would be resisted.

SLaM is a high-status organisation with significant teaching, research and specialist work. The regard it is held in has sometimes obscured the problems it has faced providing local services.

Meanwhile, the turnaround in SWLSTG’s fortunes is probably underappreciated. Under Mr Bradley’s leadership, it largely escaped the shadow of previous failures while delivering significant reconfiguration plus new housing.

The departure of SLaM’s previous chair after four-and-a-half years (not a round number) suggests there could have been disagreement about the direction things were moving in.

Croydon Health Services Trust in south central London has already combined nursing director and chief executive roles across the CCG and trust.

Further west, the recent announcement of a shared chair between Epsom and St Helier University Hospitals Trust and St George’s University Hospitals is interesting. It’s not clear what problem that move was designed to resolve, suggesting the goal instead is a general reduction in the number of independent chairs.

Where something might be expected is the oft-overlooked Hounslow and Richmond Community Healthcare Trust.

Chair Stephen Swords had been due to leave in March but no one was appointed. He is due to remain there until December or the appointment of someone new, whichever is sooner.

Chelsea and Westminster Hospital’s West Middlesex site serves a fair bit of both these boroughs’ populations.

The only remaining non-FTs, continuing clockwise, are in north west London: West London Trust, Imperial College Healthcare Trust, Central London Community Health Trust and London North West University Healthcare Trust.

LNWUH has been gradually escaping from its previous status as an outlier on performance and finance. Long-standing chief executive Dame Jacqueline Docherty is departing and chair Peter Worthington was appointed in 2015, so there is probably potential for consolidation at the top, if there was willingness elsewhere.

Now that Lesley Watts, Chelsea and Westminster Hospital boss, is SRO for the North West London Sustainability and Transformation Partnership , it might mean the most successful trust in that corner of London is prepared to take a more active system leadership role.

Change at CLCH seems unlikely, ditto Imperial, given its chair was only appointed in May and has a four-year term.

West London Health Trust has also done much better under its new leadership team than previously so it’s not clear what a shared chair or exec arrangement would achieve.

There’s likely to be news on the theme in a few places before the end of the year.