The giant Midlands and East strategic health authority cluster held its first full board meeting as a monolith last week.

It was a chance for each constituent region, now led by Sir Neil McKay, to take stock and reflect on challenges ahead. This was particularly important for the West Midlands in two respects: one is the spectre of Mid Staffordshire Foundation Trust.

The second is the fact that Ian Cumming, formerly chief executive of NHS West Midlands, was appointed in August as national managing director for quality. He has been asked by NHS chief executive Sir David Nicholson to examine best practice for handover arrangements. It would be embarrassing for this to fail in his own backyard.

Part of the stocktake inevitably concerned the foundation trust pipeline. A report noted 38 NHS trusts within the Midlands and East cluster are yet to become foundations – more than a third of the national total. The biggest proportion, amounting to 17 trusts, is in the West Midlands.

Robert Jones and Agnes Hunt Orthopaedic and District Hospital Trust was the first in the region to be authorised in 18 months – and that was back in August.

To tackle the backlog, a cross-cluster provider development board is being established as a sub-committee of the SHA board and a “rules based” provider management framework is being put together.

The board will retain a “tight grip” on assuring delivery of the FT pipeline, papers say. Hoping to escape the regime will be Royal Wolverhampton Hospitals Trust, which already has an “active” application, and West Midlands Ambulance Service – due to submit its application next quarter.