Our map shows the spread of current and proposed major collaborations between whole acute trusts across England, including mergers, acquisitions, shared leadership and chains. 

HSJ’s analysis identified 53 acute trusts that are part of the collaborations mapped below – around a third of the total English acute and specialist trusts. Seven of the groups, involving 14 trusts, have a shared chief executive.

We have included collaborations which represent a significant shift away from independent governance and management, affecting a broad range of the trusts’ activities. We have not included less substantial joint arrangements, such as networks for single service areas, or shared back office or procurement ventures, for example.

Several factors are pressing NHS providers to work more closely together. They are seeking to make very large efficiency savings particularly from non-clinical costs; to share scarce workforce – both clinical staff in key specialties and very senior management; and to join forces in an effort to create sustainable organisations and clinical services.

The national new care models programme promotes “acute care collaboration”, and there remains support in national policy for Sir David Dalton’s December 2014 review, which advocated more organisational collaboration through “foundation groups”, federations, joint ventures, management contracts, and other means.

Mapped: The NHS trusts merging, forming chains or building alliances