- The move towards system working, greater provider consolidation, and in some instances a drive to improve quality or become more efficient, has led a number of trusts to consider certain joint appointments including sharing a single chair for the medium or long term.
- While chairing more than one provider trust presents challenges and risks, none of these are insurmountable nor are there fundamental legal or governance impediments to such arrangements. The risks commonly identified include:
- a need to manage potential conflicts of interest
- time management and capacity
- The need for clear governance arrangements including around appointment and removal of the chair.
- The benefits commonly identified include:
- cross fertilisation of cultures, learning and practice
- supporting integration as organisations work towards merger/acquisition or where trusts have common strategic interests
- mutual support
- collaboration in service provision
- building relationships across trusts and helping to stabilise leadership teams
- more joined up care, support for system working and a potential decrease in competition in the interests of patients.
- Based on those we spoke to, the pre-conditions for success are likely to include:
- a clear, strategic rationale for the adoption of the model (rather than to force consolidation when this may not be the right strategic option) – this was seen to be strongest when it was locally led with the support of the boards concerned, rather than being seen to have been imposed by NHS England and Improvement
- sufficient commonality of interest between the trusts concerned
- ensuring that the joint chair role can be performed effectively not just by the incumbent but by a successor who may have less history with or experience of the trusts concerned
- engagement and support of local stakeholders in the context of system working – and of regional and national regulators.