In the summer of 2015 we published our paper We need to talk about boards, in the context of the Five year forward view and the debate that ensued about legal and organisational forms. Much has changed since then, with the publication of the NHS long term plan and the drive towards system working, with its emphasis on collaboration rather than competition.

However, even in the context set out above, individual organisations remain important. They are the only bodies corporate within systems with the legal powers to make decisions and are legally accountable for the outcomes of that decision making. Their directors are answerable to the board even when making decisions under delegated powers and all board members are liable for the ensuing outcomes. For providers, this means the board, which embodies the organisation, remains the legitimate unit of decision making. So while system working is likely to impact on the way in which boards work, it has made board oversight more important than ever.

The policy emphasis on collaboration over competition makes legislation to revise NHS structures and ways of working more likely at some point in the future. When this is brought forward, whatever the shape of the resulting organisations, it is vital that board leadership should be at its heart. This revised version of our 2015 paper sets out our rationale for board leadership now and in the future.