One Chief Executive, Two Boards: South London’s NHS Slashes Its Management Layer

NHS South East London and NHS South West London now operate as a cluster under shared leadership. The two integrated care boards plan and secure health services for a combined population of four million Londoners across 12 boroughs. Andrew Bland, who has been chief executive of the south east London board since its creation in 2022, leads both organisations. The Secretary of State appointed Sir Richard Douglas as joint chair in February.

Sharing leadership has not merged the two bodies. Both boards remain separate statutory organisations with their own boards and legal responsibilities. Each keeps its own geographical area and financial allocation, and each stays accountable to the residents it serves.

The change follows a national instruction on administrative spending. In March 2025, integrated care boards were asked to cut running costs by around 50 per cent and to concentrate on strategic commissioning. South West London faced a steeper target. Its board was told it must reduce overall running costs by about 58 per cent to meet its new allocation. The boards of both organisations decided to cluster in 2025, sharing a chair, a chief executive and an executive team.

London is not the only region to have restructured.The boards covering Sussex and Surrey Heartlands were scheduled to become one organisation from April 2026. A merger removes one board entirely, whereas a cluster keeps two boards in place and combines the people who run them. The south London boards have not announced a merger of their boundaries, and any future decision is expected to be tied to wider local government reorganisation.

The executive team is being assembled in stages. In April the boards confirmed Elaine Clancy as chief nurse and quality officer across both organisations, a post she previously held at South West London. The appointments bring some executive roles together as the boards strengthen their position as strategic commissioners. A single team now sets commissioning priorities across the whole of south London, and the overheads of two separate executive structures are reduced.

Leaders of both boards present the arrangement as a gain in planning capacity. Their annual report says closer collaboration across south London should strengthen the ability to plan and commission services, while each board stays answerable to its own communities. The savings target applies to running costs, which means the cluster must absorb a much smaller administrative budget with fewer senior posts and fewer duplicated functions.

Care delivery remains rooted in the boroughs. Place-based partnerships bring together councils, the NHS, voluntary organisations, social enterprises and community groups to tackle health inequalities close to where people live. A paper presented to Merton's older people scrutiny panel describes a place lead for the borough, a memorandum of understanding and an alliance of health, care and voluntary sector partners that will be co-hosted in 2026/27. Similar arrangements operate in the other boroughs, and they are the main route by which local authorities influence how NHS money is spent in their areas.

Those structures were built when each board had its own full executive team. With senior commissioning staff now shared across two organisations and 12 boroughs, the partnerships will deal with fewer people who each cover a wider patch. Council leaders and voluntary sector bodies will watch whether that affects how quickly local decisions are made.

The Test for the cluster is therefore twofold. The boards must show that the combined team delivers a measurable reduction in administrative spending, in line with the national target. They must also show that boroughs in the south east and the south west both retain a clear voice in decisions on local services. Neither board has published a full assessment of how the shared model has performed against those aims.