Mark Hackett, the interim chief executive of the newly formed South West Peninsula integrated care board cluster, has temporarily stepped down from the post after only three months in the job. The health service confirmed on Friday that Hackett's departure is for personal reasons and that a temporary successor has already been put in place to keep the organisation running while he is away. No timetable for his return has been given, and the cluster has been careful to frame the arrangement as a pause rather than a resignation.

Susan Bracefield, who joined the cluster's executive team as chief clinical officer and chief nursing officer at the start of April, has stepped up to become interim cluster chief executive in Hackett's absence. Bracefield previously served as acting chief executive of NHS Cornwall and Isles of Scilly before Hackett's arrival, giving her direct familiarity with both the board and the wider system she is now overseeing. Officials at the cluster have stressed that she is being supported by the rest of the senior executive team, and that day-to-day operations, financial reporting and governance arrangements will continue without interruption.

The scale of what Bracefield has inherited, even temporarily, is considerable. Hackett was appointed in March 2026 to lead a single executive structure spanning NHS Devon and NHS Cornwall and the Isles of Scilly, two integrated care boards operating under one board, one leadership team and one staffing structure ahead of a formal merger expected in 2027. The clustering model was designed to bring the two systems into closer alignment well before that legal merger takes effect, meaning that whoever holds the chief executive post is, in practice, already running a combined organisation covering a substantial and geographically stretched part of the south west.

Hackett arrived with a long record in NHS leadership behind him. He had most recently served as interim chief executive of University Hospitals Plymouth NHS Trust, which runs Derriford Hospital, and before that spent more than two years as chief executive of Swansea Bay University Health Board, where he oversaw a reconfiguration of hospital services across south Wales. He was brought into the peninsula cluster on an initial twelve-month contract specifically because of that experience in large-scale clinical and financial transformation, the kind of turnaround work the cluster's board judged necessary as it absorbs two systems into one ahead of merger.

His departure, even a temporary one, lands amid wider and more structural pressure on integrated care boards. The Department of Health and Social Care has directed ICBs across England to cut running costs sharply and narrow their focus to a more strategic commissioning role, and clustering arrangements like the one covering Devon, Cornwall and the Isles of Scilly are one of the principal mechanisms through which that cost reduction is meant to happen. Boards that have merged executive teams while retaining two statutory bodies are, in effect, being asked to do more with fewer senior leaders, at the same time as those leaders are expected to hold together local relationships, financial plans and delivery commitments built up separately over years.

That combination has already proven difficult to sustain elsewhere. Several ICB chief executives have left their posts abruptly in the months since clustering began, some citing the strain of running larger, newly combined organisations on tighter budgets. Hackett's temporary absence, whatever its cause, will inevitably be read against that backdrop by other systems watching how the peninsula cluster copes. For Bracefield, the immediate task is straightforward continuity. For the wider NHS leadership community, the episode is a reminder that the human cost of rapid structural reform tends to fall hardest on the people asked to hold new, larger organisations together before the ink on their mandates has properly dried.