NHS mergers 'damage health service'

Mergers may 'divert attention from patient care'

Mergers between NHS trusts are poorly thought through and do nothing to improve the service to patients, research suggests.

A study has found that the mergers - which are on the increase - are often more of a 'takeover' than a merger.

There might be four miles difference between us but there is two decades in terms of culture and practice

Executive board member, acute trust

They cause tension among staff, have no impact on recruitment, fail to reduce management costs and cause delays of at least 18 months in the development of services.

The researchers, from the London School of Hygiene and Tropical Medicine, interviewed 96 people involved in nine trust mergers.

They found that cultural differences and conflicting priorities often caused problems between merged trusts, increasing both the workload and stress of staff.

There is a 60% vacancy rate in school nurses, and that's because of the merger

Manager, community trust

The researchers also found that two years after merging, trusts still had not met their objective of saving £500,000 per annum in management costs.

There were some positive aspects associated with merger.

These included:

• the creation of a larger pool of professional staff
• a feeling among community trust managers that they were taken more seriously by local authorities now they were working in a bigger trust
• increased opportunities for staff training
• enhanced professional networks

Lead researcher Dr Naomi Fulop said: "This study clearly shows that mergers have major unintended consequences that must be taken into account when future mergers are being planned.

You become more business-oriented and it steers the agenda away from patient care

Director of operations, mental health trust

"They can cause significant disruption to services and require greater management support than has been previously acknowledged."

However, she accepted the findings provided a picture of the impact of mergers at a relatively early stage in the life of the new organisation.

"It could be argued that it is too soon to judge whether or not the mergers have met their objectives.

"The second stage of our study is currently taking place during the organisations' third year of operation, and may well show that they have moved further down the line in terms of meeting their objectives."

Benefits

Gill Morgan, chief executive of the NHS Confederation, said there were examples of effective mergers.

She said mergers were unlikely to save money on management costs, but by pooling resources they could provide an opportunity to improve the quality and range of services.

"It may take time for two organisations that might previously have been at each other's throats to begin to work together well in an integrated way.

"But in the longer term they may begin to improve the quality of services for patients."

Since 1997, there have been 99 trust mergers, 14 of which have been in London.