Stephen Eames: successful acquisitions
Recents announcements about the creation of £1bn-plus healthcare organisations in Bristol and the South East and the application of the new trust special administration regime in south London might lead us to ask if there is a magic formula for successful acquisition.
I suspect the answer is an emphatic no. Like any other major management change, acquisitions are bound to be driven by their own unique context and strategic logic.
Experience in other sectors suggests organisations often justify acquisitions by talking up the strategic benefits, arguing that the change will consolidate market position, enable transformation and offer opportunities for greater efficiency and economy of scale.
In reality, these laudable aims often act as a fig leaf for cost-cutting and takeover - so be wary and remember the old fable about Greeks bearing gifts.
Typically, acquiring organisations will articulate broad-brush benefits such as growth or strategic positioning without translating these aims into tangible outcomes. I would suggest any acquisition needs to demonstrate how the proposed change will deliver greater value to the patients and communities concerned as well as benefits to the wider NHS. So here is my five-point plan for would-be acquirers.
Does your plan improve performance? Can you deliver a better quality service by radically reducing costs and ideally generate some growth in services? In the NHS success would be demonstrated by delivering more care, at a higher standard, at less cost. Obviously this is more difficult to do if there is a debt burden to manage.
Does your plan aim to remove excess capacity? There is a crowded market in acute services and the combination of a relentless focus on quality care closer to home with austerity means a timebomb is ticking. So can you deliver transformational change in the shape of hospital services and at the same time deliver on the QIPP requirements of local commissioners by reducing unnecessary demand on acute beds? The problem with this approach is that value is likely to accrue to the target health economy and not the parent trust.
Does your plan improve access to local services? In the private sector relatively small companies can find it difficult to reach their potential without benefiting from the synergies a larger organisation can bring. Have you determined the ways in which your brand and skills and expertise in clinical services and service improvement can accelerate reductions in waiting times, generate new models of care and provide the spark for local innovation and growth? For this to work effectively there needs to be enough clinical and managerial leadership capacity available to balance resources effectively across and between organisations.
Does your plan create sustainable benefits? Typically this approach is likely to work best when there is fragmentation, making it difficult for individual institutions to achieve long-term clinical and financial sustainability. The assumption is a larger conglomerate of healthcare providers can more easily break down barriers to change by applying clinical, technological and economic muscle.
Does your plan win hearts and minds? This is probably the most important consideration. It is essential the views and aspirations of the target organisation are taken into account in any acquisition situation. Failure to do so will likely lead to poor outcomes. The engagement and commitment of major stakeholders, especially clinicians, is vital to success. This can also be extended to major stakeholders in the local health and social care economy, whose perspectives will be heavily influenced by local political and cultural forces. Understanding the softer indicators and where these players will draw lines in the sand and reflecting them in your proposals is vital.
Every acquisition is different but the principle is the same - two or more organisations coming together to enable a better and more improved position. As the potential for acquisition grows in the NHS, the assessment of the right deal for you may become trickier. As those involved already might say, acquisition might take a lot of due diligence and business nous, but it is less a science than an art.
No one ever plans to enter into a bad deal yet the literature is littered with many well-intentioned acquisitions that have led to regret. Classic mistakes include lack of adequate planning, an overly aggressive timetable, failure to look at possible integration problems and illusive synergies. Integrate too quickly and you can wreck what made the acquisition so appealing in the first place. Fail to move fast enough and you do not leverage the synergies you need to drive success.
Stephen Eames is chief executive of the Mid Yorkshire Hospitals Trust.