Greater than the sum of its parts? Sharing board leadership between NHS trusts (NHS Confederation, 6 November 2024)

Summary

Article exploring the learning from shared leadership models in provider trusts in England.

Content

Key points:

• The last decade has witnessed the biggest shift in the architecture of the NHS provider sector since the creation of NHS trusts. This has included a shift towards much larger trusts and a dramatic rise in the number of trusts sharing board-level leadership. This arrangement is now in place in a third of English NHS trusts.
• This significant change in organisational form has developed organically and been subject to little scrutiny, evaluation and research. Now, ten years on from Sir David Dalton’s pioneering review of organisational forms, this report unpacks what works and what doesn’t when it comes to shared leadership models.
• Drawing on the insights of those who know the subject best – NHS leaders who have established and led provider group models at system or regional level – it puts forward a set of recommendations for those considering similar arrangements.
• Shared leadership models offer a beneficial and pragmatic option for NHS trusts and local systems when they are delivered for the right, clearly defined and locally determined reasons and when implemented flexibly and sensitively.
• While these changes are disruptive, shared provider leadership arrangements offer an alternative approach to a merger in which a pathway towards integration and closer working arrangements can be managed and determined at a controlled pace as benefits are delivered.
• Several trust group models are already showing the benefits of working together, including more aligned clinical strategies, shared learning, joint investment in critical infrastructure and clearer routes towards clinical and economic sustainability.
• Despite the varied nature of shared provider leadership models, the NHS, national regulators and independent policy organisations would benefit from recognising, supporting and evaluating them, given the importance of these models in the evolving NHS provider landscape. National regulators, including the Care Quality Commission, should consider adapting the arrangements for inspecting and reporting on groups of separate trusts under one board, or shared senior directors, to reflect this new type of governance arrangement more consistently across England.
• The critical role that trust chairs play in the development of shared provider group models, particularly in their formative period, should be formally acknowledged, with NHS organisations encouraged to resource the role and its support arrangements.
• NHS England could benefit from developing standard governance models which are compliant with a revised NHS Code of Governance to reduce the cost and complexity of developing local arrangements. This would strengthen and simplify governance and ensure common approaches between participating trusts as quickly as possible.