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 unifica
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Contact: Emma Wilkinson
ewilkinson@bmj.com
44-207-383-6529
BMJ-British Medical Journal
1-Aug-2002