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

Ever closer union continues south of the river.

At the most recent board meeting for Guy’s and St Thomas’, chair Sir Hugh Taylor, announced the next stage of joint working with King’s College Hospital Foundation Trust, where he is also chair.

KCH’s medical director Professor Julia Wendon was at the meeting and will be working with her counterpart at GSTT on aligning clinical strategy, which is probably code for which site does what in the long-term.

To hammer this point home, GSTT’s strategy director Jackie Parrott is now also the strategy director for KCH. Hard to imagine the trusts having the same strategy director but different strategies, especially with their medical directors also working on an aligned clinical strategy.

This comes on top of the joint appointment of Beverley Bryant as IT director across both organisations.

It’s hard to see exactly what autonomy King’s will retain in the medium future.

Perhaps streamlined accountability would have avoided the recent dispute in haematology.

Medics from both trusts were forced to explain to their boards how they had resolved the differences of opinion that saw GSTT refuse to transfer some transplant patients to KCH, sending them instead to UCLH and the Royal Marsden.

At some point on a journey to full merger the governors, the much-overlooked holders of the statutory control of FTs, will have to approve it. It would after all be a significant transaction for both boards.

As well as making some points about performance at the trust and across the capital, Sir Hugh said goodbye to GSTT’s director of corporate affairs Peter Allanson, who is going to do consultancy work for the Good Governance Institute.

Mr Allanson has held the corporate affairs role and been board secretary for 10 years - an interesting period for the trust’s governance and structure which has underlined the organisation’s, still on-going, ambitions to extend its operation and influence.

He was in post while the trust’s estates function was spun out into wholly-owned subsidiary Essentia. Last year the trust reported that one board member who was also on Essentia’s board had a “clear potential conflict of interest”. The report said the trust should cease “any dual activities of staff” and no longer use a “Teckal exemption” whereby a public body can directly award work to an entity it controls.

Mr Allanson also inherited the raft of wholly-owned or part-owned subsidiaries set up by the trust to deliver NHS services or services to the NHS.

This included GTI Forces Healthcare Limited that worked to commission health services for the British army in Germany. The same report that mentioned the potential Essentia conflict of interest also mentioned issues with the military work and noted “concerns about procurement being undertaken outside the normal agreements”.

The trust also owns Pathology Services Limited – which in turn owns one-third of pathology firm Viapath (the other two thirds owned by KCH and Serco)

Viapath provides the pathology services to the trust and KCH and is currently fighting to retain a south east London-wide contract for another 10 years. The bidding process is approaching the best-and-final offer stage, after which the bid consortium – including representatives of KCH and GSTT – will decide between Viapath and two other bidders, HSL and IPP.

During Mr Allanson’s tenure the trust has also done significant work in taking on the running of local community services and setting up collaborations with other trusts.