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

It’s surely a good thing that London’s four sustainability and transformation partnerships and one integrated care system are getting independent chairs.

Job adverts have gone out for the five positions with pay of up to £63,000 for two to three days a week.

In practice, these jobs are not going to be doable in two to three days.

Here is the list of “key relationships” each chair is expected to have: clinical commissioning group governing bodies; NHS trust/foundation trust boards; NHS England/Improvement; health and wellbeing boards; local MPs; local (borough) political leaders; primary care networks; Healthwatch; universities and academic sector; and voluntary sector representatives.

Although, say, a hospital chief executive might already have to have these contacts, they won’t have to do it across a whole fifth of the capital (each one with between six and eight local authorities and CCGs – unless and until CCG mergers come about).

A trust chief executive also has a slightly clearer line of accountability.

The job description says the integrated partnership board which these five individuals will chair “will be held accountable to meet the objectives of the system by both the NHS regional director and by system partners – including local government”.

So the people who could remove you are Sir David Sloman and some combination of “system partners – including local government”?

The knottiness of the job itself as well as the less-than-wholly-clear-governance (how many local authorities does it take to vote out a chair?) are maybe why successful applicants will need to have “significant experience in how boards of large, complex organisations” work, and “personal credibility within their own profession along with an openness to engage with a wide range of other stakeholders”.

It will be interesting to see what kind of people are appointed.

It may well be they wield more influence here than in other parts of England, because the regional director’s office is said to be a little more active and authoritative in the capital than some of the other regions.

They are going to be exercising Sir David’s mandate as the local power in NHSE/I over everyone except local authorities – in relation to whom they will enjoy zero formal power.

Sir David notes in his foreword to the job ads that candidates will need “an unusually high degree of flexibility” and comfort with the “exercise of informal authority”.

The “10 focus areas for action” in “The London Vision” – a kind of strategy for the capital coordinated by the regional office – are commendably public health focussed: Air pollution, reducing childhood obesity, improving care and support at the end of life, and more. But these are also things NHSE/I has less direct control of.