London Eye: A pivotal month for the south east

June will be a key month for the governance of south east London.

An advert recently went out for a joint chair of Guy’s and St Thomas’s Foundation Trust and King’s College Hospital FT.

Obviously this is a big job and incumbent Sir Hugh Taylor had been parachuted into the latter, having chaired the former since 2011.

NHS England London could organise said parachuting because KCH was at the time deep in regulatory “special measures” mostly due to terrible finances. People at KCH said Sir Hugh (a former permanent secretary of the Department of Health, as was) never made them feel anything less than equals with GSTT, but their trust was clearly struggling at the time.

The big question in the three years subsequent was whether KCH had improved enough to be taken out of special measures and its governors allowed to appoint their own chair.

The answer which came last week was: yes, sort of.

KCH’s governors will appoint the new chair but that new chair will oversee both organisations and the appointment will see them make that decision alongside GSTT’s governors.

In an interview with HSJ, KCH chief executive Clive Kay stressed that the decision to have a joint chair now was because it was the best way to integrate the organisations, not a sign of continued weakness on the part of King’s.

KCH’s stock has undoubtedly risen over the pandemic with strong site leadership at Denmark Hill and the trust’s southern sites combining with its medics taking important regional roles in the critical care response.

The two trusts now share a few services, so would it make sense for them to report into different independently-chaired statutory organisations? Not really. So is a single chair a step on the way to full merger? Also “no”, it seems. Professor Kay told me a combined organisation would be too big.

GSTT recently merged with/acquired the Royal Brompton and Harefield Hospitals FT, a move that may well soon prove to have been too ambitious as doubts over capital financing to realise their grand plans in the short and medium term continue to emerge.

As well as the many operational challenges these key London organisations will face over the term of the next chair, there will be significant questions over research, training, where services get provided and who is in charge of them.

Recent history saw significant conflict between them on haematology. In the longer term south London will have to make some decisions on where cardiac work is centralised. GSTT is bidding against the Marsden and St George’s to be a children’s cancer hub, but both sides would need KCH’s strength in neurology in support. KCH’s current stance is that it will support both bids – will that stand with a new joint chair?

The person specification on the job advert requested: “Experience managing competing agendas, finding compromise and building consensus across varied stakeholder groups with potentially conflicting priorities.”

Applications for the GSTT/KCH close at the end of this week with final interviews expected on 27 June.

Lewisham and Greenwich

All that is before we even get into the question of Lewisham and Greenwich Trust’s chair.

An appointment is due to be made this month also, and the previous leadership of NHS England London would surely have insisted GSTT, KCH and LGT all have the same chair. It’s what happened in north west London and pretty much all of north east London, after all.

Perhaps SEL integrated care board chair Richard Douglas — another former DH titan — will tack in another direction; or maybe pressure from the centre will yet see a shared chair for the sector.

Sir Hugh was credited by KCH/GSTT’s joint IT director with securing funding for KCH as well as GSTT to get the Epic IT system. LGT is on a different system. If the idea is “actually, let’s put the whole ICB on the same system”, will the DHSC really shell out all the extra tens-of-millions to pay for it? If so, maybe a joint chair does make sense. If not, probably not.