Lead provider role creating ‘potential conflicts of interest’, review finds

The findings were set out in a governance review of the Birmingham and Solihull Mental Health Foundation Trust, which leads the mental health provider collaborative.

An independent review of the trust’s governance was carried out around the start of 2026. BSMHFT said the review was done internally.

The review has not been made public, but a subsequent action plan drawn up by the trust, and seen by HSJ, set out its key findings.

The plan said the review found the relationship between the trust, mental health provider collaborative and integrated care board “lacks clarity” and has “insufficient assurance mechanisms and oversight”.

As lead provider for the collaborative, BSMHFT holds the budget on behalf of a group of organisations delivering mental health, learning disability, and autism services across Birmingham and Solihull, and allocates funding across the group.

The other organisations in the collaborative are Birmingham Community Healthcare FT and Birmingham and Solihull VCFSE Mental Health Collective. The provider collaborative also works with Birmingham City Council and Solihull Metropolitan Borough Council.

The trust’s action plan said the review had found the lead provider and commissioner roles were “not well defined”, which it said risks creating conflicts of interest.

The plan said the review also found assurance processes between the ICB and the provider collaborative “lack independence and clarity”.

It committed to an “immediate handover process” for the chairing of BSMHFT’s clinical quality review meetings to the ICB.

CQRMs are regular meetings between a commissioner and provider to maintain oversight of a provider’s clinical performance.

The ICB told HSJ   that Sally Roberts, the ICB’s chief clinical and quality officer/chief nurse, would chair the meetings.

Safeguarding arrangements ‘unclear and fragmented’

The review also raised additional governance gaps beyond the provider collaborative. The Freedom to Speak Up structure and the respective roles of BSMHFT, the ICB, and NHS England were “unclear”, it found.

BSHMFT’s board papers from June said a separate external review of FTSU governance, supported by NHSE, was underway to strengthen assurance, following “ongoing challenges in confidence and perceptions of detriment” identified in staff survey results.

Separately, leadership responsibilities for education, training, supervision and quality improvement for people with learning disabilities and autism were also found to be unclear, with the review calling for clearer joint working arrangements between BSMHFT and Black Country Healthcare FT.

Safeguarding arrangements and communications between the trust, ICB and staff were “unclear and fragmented, with overlapping responsibilities and misaligned processes”, the review found.

The action plan also said that senior leaders’ narratives and the data they provide “must align” with feedback from staff and patients across all services, and flagged “insufficient communication” among divisional leads across sites, causing “gaps and duplication”.

“Repeated” reviews and oversight activity are putting additional pressure on staff and potentially “impacting morale and wellbeing”, the action plan said, adding that the trust would work with ICB and NHSE leads, initially on quality reviews, to agree a mitigation approach.

A Freedom of Information request for the review itself made by HSJ   was rejected by the trust, which cited an intention to publish it in future.

BSMHFT declined to comment further, and BSol ICB did not respond to a request for comment beyond distancing itself from the review.