Dr Jim Gardner is the Chief Medical Officer of Liverpool University Hospitals NHS Foundation Trust (LUHFT). The Trust operates across three main hospital sites, employs over 14,000 staff and has an establishment of over 1600 beds. A GP by professional background, Jim has held a variety of senior leadership roles across the NHS, university, private and charitable sectors over a career spanning more than thirty years. Moving across multiple sectors has given Jim a rather unique insight into the benefits and challenges of integrated systems and a current focus is on the development of strategies for the hospital sector that properly reflect the needs of the populations served in the context of place.