Three London foundation trusts are considering a merger that would create the single biggest trust, with a turnover of £1.9bn.

The idea Guy’s and St Thomas’, King’s College Hospital and South London and Maudsley foundation trusts could merge is set out in a report commissioned by King’s Health Partners, the academic health science centre that works with all three trusts.

The involvement of SLAM means the possible merger would also be a first in terms of combining acute trusts with a mental health trust.

Guy’s and St Thomas’ took over the management of Southwark and Lambeth community services in April.

The south London proposal is the latest in a trend for large-scale merger plans as trusts work to make cost savings. Four other proposed mergers could see organisation of roughly £1bn turnover created (see box).

The report’s author William McKee, an independent consultant, also recommends the trusts do not make individual approaches regarding possible mergers to other south London acutes, only doing so through King’s Health Partners.

Mr McKee’s report said: “I am aware of discussion with the Royal Marsden Hospital Foundation Trust and others in the context of the Cancer Networks for London. Other discussions are taking place with St George’s, Lewisham and South London Healthcare trusts.”

The document said it was unclear what the Co-operation and Competition Panel’s view of a merger would be, but that work the panel had done so far on the merger of Barts, Whipps Cross and Newham Hospitals suggested a principal concern would be the temptation to “influence” referrals so they went to the new organisation’s specialists.

Mr McKee said he had seen “considerable” evidence of “passive aggressive behaviour” between the trusts.

His report said: “The waxing and waning of support over two decades for a merger between the two acute trusts is an issue, which in turn has led to defensive and aggressive behaviours.

“An analogy would be a colourful quote ‘land grabs before the armistice’, given to me by a clinical academic group leader.”

A feasibility review is now being prepared for KHP by Peter Goldsbrough of Boston Consulting Group, the firm which also did the initial work on the North West London and Ealing Hospitals merger bid.


Dawn of the age of hospital giants?

Proposed mergers/partnerships and their combined turnover

Barts, Whipps Cross and Newham Hospitals £1.1bn

North Cumbria University Hospital + Newcastle University Hospitals + Cumbria Partnership £1.1bn

Imperial and West Middlesex University Hospital £1bn

North Bristol and University Hospitals Bristol £956m