The must-read stories and debate in health policy and leadership.

The gradual trend towards shared leadership means more chairs have taken up the same role at more than one trust, but how are they paid for their time?

New HSJ analysis has found more than a dozen are now receiving two or more salaries. 

While a single trust chair typically earns between £45,000 - £55,000, nine of those listed have been paid £70,000-£80,000 or more overall. Three are on £90,000-£100,000 and above.

The geographical spread also revealed half of them are based in London, while others are located across the Midlands, the South East and the South West.

The analysis will raise questions over how chairs of two or more trusts — joint, shared or otherwise — are paid in the future. The piece, along with comments from our readers, also point to related questions about the function of a chair of multiple trusts in a system: There are risks the role becomes overly executive in nature and time commitment, and that governance functions becomes too blurred. 

The NHS England framework on terms and conditions for trust chairs and non-execs, which was published in 2019, only applies to single trust chairs, and there is currently no guidance which specifically addresses appointments across more than one provider.

A well-placed source told HSJ discussions had taken place about issuing further guidance. With the moves towards closer leadership continuing, it could be an area which attracts further scrutiny in the future.

Shuffleboards

In the latest update on the gradual creation of integrated care systems, NHS England has said it expects board level staff at clinical commissioning groups to transfer to new ‘designate roles’ or ‘displaced positions’ within ICSs. 

The systems will then be tasked with seeking an alternative role or carrying out the redundancy process where one cannot be found. There’s no promise of the new jobs being on the same terms and conditions. 

The new HR framework adds: “Discussions about roles and responsibilities for CCG and ICB [integrated care boards, which are due to subsume CCGs’ current functions] board-level colleagues should begin in good time before the transition, with a view to securing alternative roles by agreement wherever possible.

“The aim in this change is to retain as many people as possible, however, where suitable alternative roles cannot be identified for senior colleagues, either locally or in the NHS regionally and nationally, and following full and timely consultation, redundancy on contractual terms may be appropriate.”

Compare and contrast with the previously reported on assurance for CCG staff below board level, who have been given a continued employment promise to “lift and shift” into guaranteed jobs with the same terms and conditions.