Public Release: 

Trust mergers have negative effect on NHS services

Process and impact of mergers of NHS trusts: Multicentre case study and management cost analysis, BMJ Volume 325 pp 246-9


The merger of NHS trusts has a negative effect on the delivery of NHS services, causes delays to service improvements and fails to deliver promised cash savings or improve staff recruitment and retention, says a study in this week's BMJ.

Researchers based at the London School of Hygiene & Tropical Medicine studied the process of merger in nine trusts in the capital, which took place between April 1998 and April 1999. They examined the main reasons given for merging trusts and using interviews with staff, local health representatives and by document and cost savings analysis considered, in four case studies, whether or not these objectives had been achieved by the merger.

One of the main reasons given for merging trusts was to save money. However, against projected savings of £500,000 a year, the researchers estimated that average savings resulting from the mergers were as little as £179,000 in the first year and £347,000 in the second year.

Despite citing improved staff recruitment and retention as a reason to merge trusts, the process did not improve recruitment and retention levels. In the majority of cases the merger actually had a negative effect on staff morale. The process was found to cause tension between staff and management, and staff stress levels were increased by the uncertainty and added workload associated with merger. After the merger it was common for staff to feel ignored by senior management and for the management and staff of one trust to feel dominated by the staff and management from the trust with which they had merged.

Senior management often underestimated the timescale and amount of effort involved in the process of a merger and planned service improvements were often delayed by up to 18 months after the merger had taken place.

However the researchers found that trust mergers do have some benefits including the creation of a larger pool of professional staff, improvements in staff training, the unification of previously fragmented services and the cross-fertilisation of ideas.


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