Risk, devolution and leadership with James Sumner

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.