Joint or group posts

What are joint or group posts and leadership?

Group or joint posts and leadership is where a leadership position is held by one individual, but the role and postholder has powers and responsibilities across two or more organisations.

While the terms shared leadership and joint leadership are often used interchangeably, we prefer to use ‘joint’ here because shared leadership has other meanings (about devolving leadership within organisations) which could lead to confusion. It is also more commonly used terminology when such posts are created, such a joint chair or joint chief executive.

What are the options for joint posts and leadership?

In recent years there has been an increase in establishment of joint posts across NHS organisations and examples of joint leadership can be found across the NHS in England.

Commonly, joint leadership is in the form of a joint chair and/or chief executive, although as relationships between organisations deepen other board members, both executive and non-executive, may take on joint roles. Joint executive director roles are sometimes established to deliver on large scale strategic programmes between trusts, such as a joint chief digital officer across two organisations delivering a single electronic patient record.

What are the formalities for putting in place joint or group leadership?

For joint or group directors of NHS bodies the statutory requirements for board appointments will need to be followed.

For FTs:

• The chair and NEDs are appointed by the council of governors[1].
• The chief executive is appointed by a committee of the chair and the non-executive directors.[2] The appointment of the chief executive must be approved by the council of governors.[3]
• The executive directors are appointed by a committee of the chair, chief executive, and NEDs.[4]

For NHS trusts:

• The chair and NEDs are appointed by NHSE[5].
• The chief executive is appointed by a committee of the chair and the NEDs[6].
• The executive directors are appointed by a committee of the chair, chief executive and NEDs[7].

Where you want to increase the number of board appointments to allow for joint posts you will need to consider the maximum number of directors for each organisation:

• For NHS trusts this may require an amendment to its establishment order, which would require a statutory instrument to be made by the Department of Health and Social Care. But note that in any event the maximum number of directors of an NHS trust is 12 excluding the chair, with a maximum of five executive directors.[8]
• For FTs this may require an amendment to the trust’s constitution to increase the number of directors, and the number of NEDs (excluding the chair) should equal the number of executives[9].

Considerations

• Joint leadership may increase strategic alignment between organisations and enable relatively simple joint decision-making as decisions can be delegated to an individual joint executive director or a committee of joint directors. Group posts may do the same across group structures.
• Capacity and bandwidth, and so support available, for joint and group postholders should be carefully considered. Depending on the degree of strategic, governance and operational alignment between the organisations or divisions, these individuals may be taking on a significant additional burden. Where there is not alignment, deputy directors may need to provide capacity for example, but care would need to be taken about their reduced delegated authority.
• Joint leadership is a flexible option for collaboration as it can range from one individual being shared to all board members being shared. As the number of joint director posts increase, the rationale for a full merger or moving to a group model might take on more weight.
• The statutory formalities for appointing joint directors should be carefully considered. Those making the appointments will need to be convinced of the benefits and that the postholder will have adequate capacity to fulfil their directors’ duties in each organisation. It is also possible that the arrangements may be perceived to be ‘merger by stealth’. For appointments in FTs made by the council of governors, it will be important to involve governors early and manage the appointment process to ensure that you take your governors with you.
• Individuals undertaking joint roles across organisations should be supported to understand their duties regarding managing conflicts of interest and the organisations should ensure their policies/procedures are explicitly updated to cover joint post holders, to inform and support transparency and decision-making that is free of bias, whether perceived or actual.
• The contractual employment arrangements for joint or group executive directors should be carefully considered (for example, whether separate contracts will be held with each employing organisation, or the employee enters into one contract with both organisations). Arrangements for holding the employee to account according to one or other organisations’ policies and procedures (where these are not standardised) will also need to be clarified, as will arrangements for dismissing joint postholders, should that be required.

What is an example of joint leadership?

Examples of various joint posts are included in our Mid and South Essex and Leicestershire Partnership and Northamptonshire Healthcare Group case studies but there are numerous examples including: North West London Acute Provider Collaborative (which has a chair in common across four trusts), Dorset County Hospital NHS Foundation Trust and Dorset HealthCare University NHS Foundation Trust (joint chief executive and joint chair), and Kings College Hospital NHS Foundation Trust and Guys’ and St Thomas’ NHS Foundation Trust (joint chair and joint chief digital information officer), amongst others.

[1] Paragraph 17(1) of Schedule 7 to the NHSA

[2] Paragraph 17(3) of Schedule 7 to the NHSA

[3] Paragraph 17(5) of Schedule 7 to the NHSA

[4] Paragraph 17(4) of Schedule 7 to the NHSA

[5] Regulation 3(1) of the 1990 Directions

[6] Regulations 3(2) and 17(1) of the 1990 Directions

[7] Regulation 3(2) and 18(1) of the 1990 Directions

[8] Regulation 2 of the 1990 Directions.  This is increased to a maximum of 14 directors, excluding the chair (and a maximum of seven executive directors) for approved mental health trusts and care trusts.

[9] Section B 2.7 of the Code of Governance