HCSA President Matthew Swindells explains in a new HSJ article how shared governance, common goals and local autonomy can drive improved healthcare outcomes in a complex environment:
The formation of provider collaboratives has become the fashionable reorganisation du jour. As chair of the North West London Acute Provider Collaborative, I probably do one call a week with chairs and non-executives around the country asking what we have done and whether it might work for them.
I was appointed as the chair of the four acute providers in NW London in April 2022: Chelsea and Westminster Foundation Trust, The Hillingdon Hospitals FT, Imperial College Healthcare Trust and London North West University Healthcare Hospitals Trust. We serve a population of 2.4 million people and have the full range of regional and national specialties represented in our hospitals.
We have around 35,000 staff, a £3.5bn turnover, two FTs and two non-FTs and, at the start, one trust in each of NHS England’s four provider segments; we have now improved to one in NHS Oversight Framework segment 1, two in segment 2 and, one in segment 3, so clearly we still have our share of challenges.
Initially, I chaired four separate boards. Our trusts had developed strong working relationships during covid and teamwork at an operational level was much more prevalent than had been the case in decades prior to covid. However, it was also clear that unwarranted efficiency, quality and access variation was widespread across our sector and that the drive to a population focus for our services would require more than ad hoc mutual aid.
Over the following six months, we consulted with both councils of governors, our eight London boroughs, the integrated care system, the region and NHSE to get permission to bring our four boards together into one board in common, which is both the collaborative board and the board for each of the four trusts. The individual trust boards only meet once a year at their annual general meeting.
We have maintained full accountable officer structures with a CEO, a CMO, a CNO, a CFO, and a COO in each organisation. We also maintained local governance with quality, finance and performance, people and audit board committees in each trust to ensure that we didn’t lose “Ward to Board” oversight.
We have created a matrix leadership structure with each of our non-executives sitting as a board member for two trusts (they chair a committee in one trust and sit on two commmittees in another) and each of the chief executives has a cross-cutting responsibility for people, F&P, quality, digital or estates, which means them meeting regularly with the relevant members of the other trusts’ leadership teams and reporting to a collaborative wide board committee.
Our uniting ambition is around our population, not the institutions. Levelling up equity of access and quality of care for our population, making our trusts collectively an excellent place to work, working together to drive productivity and efficiency and playing our part to make North West London a healthier, wealthier place are the things by which the collaborative judges itself. In this, we are aligned with our integrated care board, who have been a wholly positive force in creating the provider collaboratives in acute and community/mental health and then delegating responsibility to them.
Date: 24 April