Joint leader for four trusts with £3bn income

The chair positions at London North West University Healthcare Trust, The Hillingdon Hospitals Foundation Trust, Chelsea and Westminster Hospital FT and Imperial College Healthcare Trust are either already vacant or soon will be.

The trusts are the latest in a succession of London trusts to move to a shared chair, but this is believed to be the first agreement across as many as four trusts. Two trusts has been the norm to date.

The north west London arrangement will also be one of the largest groupings by annual income. The four trusts’ together have around £3bn income, similar to Guy’s and St Thomas’ and King’s Foundation Trusts in south London, which already share a chair.

The North West London ICS will coordinate the appointment process. The timetable is not clear, but NHS England and the two foundation trusts’ boards of governors have approved the decision to appoint a joint chair, they announced on Friday.

A paper to C&WFT’s governors earlier this month revealed the health system’s leadership will also “develop proposals to ensure there is robust grip and control within each acute trust, and across the sector, to deliver the required improvements and to ensure that structures and processes are secured to make the role of the single chair feasible and attractive”.

They will “set out details of governance arrangements, alignment with statutory responsibilities and the emerging NWL ICS, and the day-to-day operating model”.

Between them, the health system’s acutes run 12 hospital sites serving a population of nearly 2.5 million people. They have already been sharing senior appointments. LNWH and THHFT share a chief information officer, as do Imperial and CWFT. THHFT and CWFT share a chief people officer.

The four trusts have formed a joint acute care board made up of the trusts’ chief executives, medical directors, nursing directors and chief operating officers.

The health system has an underlying financial deficit of 9 per cent of income in 2021-22, the system leaders wrote in their paper to the CWFT governors. However, “deficits are not evenly distributed between trusts, which, in past years, have had differential success in delivering improved performance in part due to differing infrastructure”.

The paper added closer collaboration would address this, including by facilitating “one common NWL patient tracking list supported by one system of clinical governance, one standard operating model and one financial model”. It will also aid “the reallocation of resources (money and people) between trusts” and “more effective capacity planning”.

Chelsea and Westminster FT chief executive Lesley Watts is currently executive lead of the ICS. Its chair is McKinsey senior partner Penny Dash.