The must-read stories and debate in health policy and leadership.

Unhappy union

There are a few reasons organisations are loath to formally merge.

One of the main ones is the discord and distress it causes as long-established teams realise they may have to reapply for jobs in a new structure, competing with their peers in the other organisation(s).

This is what happened in Mid Essex Hospitals, an employment tribunal judgment released last week revealed. The trust is in the process of merging with neighbours Basildon and Thurrock University Hospitals Foundation Trust and Southend University Hospital FT.

The three heads of HR at Mid Essex who brought employment tribunal claims – one of them successfully – suspected the restructuring was not being carried out in good faith.

The judge threw out most of their claims but the level of discord created by the merger – in the HR function, which you might suppose would be best prepared – was significant.

The case also reminds us of the whopping redundancy payments that often need to be agreed. These get recovered over the course of time in a leaner organisation but invest-to-save is not something the NHS is usually keen on.

And, in common with many merger processes, the team leading the reorganisation realised the significant amounts of organisational memory they would be losing.

None of this it to say mergers are not reasonable, or even necessary.

But in this part of Essex a few things seem to have gone wrong, not least because another director at the trust also won her case for unfair dismissal late last year as part of the same trust-wide restructuring process.

The merger process in Essex also saw more than one employment tribunal case brought by medics as the structure across Mid Essex, Basildon and Southend was considered.

These decisions can be painful and the process of taking them and seeing them through thankless. But it is sometimes the only way of actually optimising patient care.


The NHS pensions crisis is seeing vital diagnostics work being outsourced to Oz, due to a shortage of consultants taking on additional elective work.

Doctors’ union the Hospital Consultants and Specialists Association has been told by its members the punitive pensions tax rules are forcing trusts to outsource work at great expense to keep waiting lists at bay.

Along with an increase in outsourcing union members also reported an increased use of agency locums to manage waiting lists. Trusts are in a catch-22 situation – watch waiting lists growing or break the cap for agency spend.

The HCSA has warned the reduced income from activity and the rising use of locums threatens to “eat up” funding marked for the long-term plan.

With the government consultation on doctors’ pensions still to run until the autumn, there appears to be no quick fix on the horizon.