The 10 year health plan published by the Government signalled important changes to the NHS provider sector. Safron describes the aspirations as “back to the future” with freedoms and accountability being described together. However the difference is the context with the need for foundation trust model to be fit for a new age. This must allow providers to innovate, but within a modern and update governance model. The model must be judged against outcomes and freedoms to linked to accountabilities.

Saffron reflected that many of the ‘group models’ had been born out of the desire to meet local needs differently. However there was a need to have a national set of principles guiding the development and instigation of groups - potentially around: value, staff benefit, improvements in population outcomes and being well governed.

All models need great leadership at CEO and chair levels. The group chair needs great experience and therefore is probably not suitable for those without great executive or non executive experience already. The pipeline for future CEOs is bright, but the reality is that some of the sub accountable officer group/site role are as good training and development as a smaller accountable officer role could be.

Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

University hospitals of Liverpool Group (https://www.uhliverpool.nhs.uk/) is led by James Sumner. The hospitals Group came about from a recognition that despite having many specialist hospitals in the city, residents were not getting help at the right time. 5 different hospitals were undertaking their work separately and there was the need to support General Practitioners to access diagnostics more easily. The first priority was for women and maternity services to ensure standards improved.

The hospitals in Liverpool have a long history of Trusts and their locally supported brands. The balance in the group is the benefits deriving from scale and size balanced with local delivery. Each site has its own autonomous leadership team and the Group board then links across the organisations. The oversight of the Group is underpinned by an enhanced risk approach and the management teams and Group Board use assurance and risk registers to discuss the important aspects of care. A rigid governance approach ensures continuity and a standardised approach- this is blended with a delegated framework for leadership. There are five simple rules that cannot be altered across the trusts in the Group and these are not altered unless all relevant people in the group are involved and included to change. The risk approach is based on a 5x5x5 framework that involves a clear approach on the effectiveness of the controls over a risk.

The approach took time to develop and individuals and teams needed support to adopt this way or working.Internal audit was used extensively to test out the risk approach. Most leadership i site specific but there has begun to be cross organisational leadership, especially where organisations share sites.

This shared approach had in genesis in external reviews that were taken on specific organisations and clinical services and NHS England the local Integrated Care Boards both encouraged a different leadership approach to make service change happen.

The Group CEO has to stay out of the operational leadership teams and trust them to make their own decisions. The role needs to be focused on strategy, management of the local and national politics and negotiate a future for what the Group does. The role has to support leaders to flourish and know when to get out of their way!

The future for the Group will include a shaper for us on research; digitalising how care is organisation and delivered and support o make improvements in the health of the local population.

Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

Barts Health is an organisation that delivers care from 5 hospital sites; has 40 operating clinical units; employs around 24 thousand staff and spends around £2.5bn of public money. Each site has its own leadership team, headed up by a site CEO and over all of this is an organisation wide executive team, with shared support services - with Shane as the organisational CEO and accountable officer.

The organisational operates with local identity and delivery, supported by the benefits of being part of a larger organisation. It has worked hard on reducing variation; develop hospital site leadership; used clinical networks to drive out variation and all supported by shared support services.

Clinical networks work hard to establish how teams can be best in class and support across sites with capacity issues.

The Group arrangements to include Barking and Havering hospital saw Shane appointed as the CEO; a shared Chair with Barts Health and the ambition to seek improvement and use some of Barts experience and capacity. Following the departure of the joint chair - separate Chairs were appointed and it was agreed to unravel the Group arrangements. Shane now leads/Chairs a formal partnership of acute providers/collaborative between Barts, Barking &Havering and the Homerton hospital. There had been little intertwining of infrastructure between the two organisations, therefore the unravelling was not difficult.

The acute collaboration focuses on three key areas that were important to the three hospitals.

Being the group CEO is a privilege; very varied, but important to keep the people/staff experience at the forefront of his role to ensure values, behaviour, inclusion and equity are a core focus. Shane plans to be in a different hospital each day and his key role is to create the environment for leaders to flourish. The balance is to ensure the culture is good, but always with a razor sharp approach on delivery and performance.

Shane describes how his style has changed in the Barts health role - felt it would have been difficult to move into the role without multi-site experience (which he got at Bart’s before he was appointed CEO0. He learnt how to work through people and adapt to support change - not direct everything.

Discussed succession issues and the opportunity for future CEOS - Shane felt that site CEOs =, under an accountable officer, were a great opportunity for people to learn their trade and become more confident.

Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

Angela Hillery took on the group CEO role across the two mental health/community NHS Trusts in Leicestershire and Northamptonshire in 2019. The arrangement of joint leadership was initially to provide support to one of the organisations that was experiencing some challenges with leadership and quality. Over time the two Board realised there was benefit for both organisations.

The two trusts remain as separate organisations with their own Boards. Roles were shared where there were gaps in leadership and opportunistically moved to a joint chair relatively recently.

The group approach is operated through a joint committee - there they agree on joint work which has included, governance, tackling racism, social value, talent management, quality improvement and collaboration. they have created joint thinking through involving the non executive directors; developing Boards together and creating relationships.

Angela described how merger and reducing independence is not something they are looking at. Currently their analysis is that there is no value in merging and they are focused on what each organisation wants to change and the value from working in a Group.

The CEO role can only be successful if there is a great team of support around them. Angela has a managing director in each organisation. The CEO has to lead the cultural changes - be intuitive about how change has to happen; change for the right reasons, not just because it is expected and manage risks tightly.

Advice for others in a similar position would be -1) bring executive teams together early and send regular time together 2) create a talent pool across organisations and support talent to thrive.

Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

Two hospitals in luton and Bedford came together into one Trust in 2020. There had been over 10 years of discussions and speculation about the Bedford hospital site/Trust, which had the challenges of a small district general hospital and working effectively 7 days a week in all specialisms. The two hospitals had a long history of collaboration and the coming together provided economies of scale and was birthed from a politically charged debate about essentials on the Bedford site. The merger was underpinned by a commitment to maintain maternity, AandE and children's acute unit on the Bedford site.

The local context is that local communities are wrapped around three large towns and small conurbations and the two hospitals serve these.

David describes how they have developed cross site leadership roles for general managers and clinical directors - this has enabled benefits for each hospital site. The approach was influenced by the approach used at Barnet and Chase Farm hospital sites. Goal is for single teams across sites, no divisions - a flat leadership structure - reporting directly into executives.

The merger was transacting as an acquisition, but they have culturally developed the approach as a merger. Trust has taken time to develop -but with joint roles; merged colours/new lanyards/executive teams on site in person across both hospitals throughout the week.

The merger transaction concluded just as the pandemic took hold, which in some ways made things easier as many of the established rules and ways of working changed.

Looking forward the larger Trust will ensure there is a larger pool of talent to draw from; developing clinical leadership is easier to support and staff can be at the very heart of all the developments across the organisation.

Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

The Group covers North Bristol Trust, University of Bristol hospital and Weston Hospital Trust. The Trusts had discussed alignment for some time as they faced fragile service arrangements, competition between the organisation for staff and capital and too much time responding to ill health rather than developing anticipatory models of care.

The collaboration started initially with a joint clincial strategy, which developed into a single accountability framework that the Trust Boards signed off in December 2023. A joint Chair and then a joint CEO followed. This approach was supported by site managing directors.

What made a difference initially ? 1) enthusiasm of clinicians 2) permissions to do things differently 3) focusing on the commonalities, not differences 4) proud organisations wanting to do things differently and developing joint digital approaches.

The Boards developed a joint approach by describing their challenges and working on joint challenges together. This always involved putting a patient first methodology and developing a common improvement language and approach. The Trusts formally evaluated the group approach judged against the outcomes they wanted to achieve.

Now the group has around 28K staff - develops work together; shares leadership approaches and have developed mature leadership teams, underpinned by a health research ethos.

The Group CEO role is different to single hospital CEO roles because Maria has to be out of the detail, delegate to her teams and focus on approaches that drive the benefit of working together. This means working through what is right for the population and is already then leading to different investment decisions. Control has to be delegated to teams and data analysis has to be enhanced to ensure the focus is on the right issues.

Maria describes how she had been used to a set of personal relationships and that underpinned how she worked effectively. Now she has to focus on maximum impacts; better use of data; work with teams across sites to make improvements; be non partisan; be an arbiter; narrate and manage relationships with external partners.

Looking to the future, Maria see the duty to collaborate and cooperate in the public realm as being crucial. Supporting a new set of senior leaders is going to be key. As a leader you must be courageous, curious and look to improve care all of the time.

Matthew Winn, podcast host and an experienced leader in healthcare in the UK.

Encompassing South Warwickshire, Wye Valley, George Elliot and Worcestershire Trusts, the Foundation Group covers three counties and provides acute and community health services.

The joint working of the Trusts is voluntary, with Trusts choosing to join the Group and operate in the way that has developed. With Committees in common, joint roles for the CEO and Chair and other executive roles, opportunistic approaches have flowed from the collaboration.

The Group has enabled new ways of working to be tested and sharing and adoption of this practice to be adopted at pace.

The “back office” infrastructure is shared where it makes sense, but there are differences and local approaches.

Glen has been a CEO for over 18 years so the joint approach builds on his experience and outlook. His approach has been to always encourage people to make change and challenges thinking. Success happens when decision making iOS devolved and people are supported in accountable structures/cultures. Importantly staff and services must be supported to take risks and learn what works.

As Group CEO, Glenn has had to move to a more coaching style as he cannot be so hands on. He still needs to be able to discharge his accountable officer role properly but does this increasingly by working through others. He needs to be able to provide the ‘air cover’ for the site based managing directors, so they can do their job effectively.

Looking forward - the Group is not dependent on Glen alone to succeed. All of the organisations can walk away from T he Group at any point and make their own choices.

The leadership role is to convene; scale up population health approaches; work as an integrator; earn the trust of others to support better care delivery. NHS organisations don't have to provide and lead everything -but must break new ground and evolve.

Matthew Winn, podcast host and an experienced leader in healthcare in the UK.