A third of NHS trusts now share a CEO or chair. On paper, it looks like efficiency. In reality, it’s a symptom of leadership fragility across the system.

Leadership churn is already high, nearly two-thirds of trusts had a first-time CEO in 2023, and a third of CEOs had been in post less than 18 months. Shared roles stretch leaders across multiple complex organisations, diluting oversight and slowing decision-making just when grip is needed most.

For staff and patients, this matters. A revolving door at the top makes it harder for teams to feel supported and for long-term strategies to stick. And when governance is stretched thin, accountability suffers.

Shared leadership may save on salaries, but it creates shared risk across entire systems. Cutting back on leadership capacity is as short-sighted as cutting clinical flexibility: both weaken resilience when the NHS needs it most.