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There was probably only one possible ending for the governors vs board dispute at one of England’s smallest trusts – and it now seems to be drawing to a conclusion.

A slim majority of governors at the Queen Victoria Hospital Foundation Trust in West Sussex are opposed to plans for a merger with University Hospitals Sussex FT, fearing the south coast behemoth would swallow up the tiny QVH and some of its specialist services would suffer.

Governors called for a pause in work towards this and were rebuffed by the board. But now NHS Improvement has weighed in, imposing additional conditions on the trust which effectively means the governors are being told to get on with the merger.

The NHS Improvement letter revealing this is couched in terms of working towards a sustainable future for the trust, of course, but as far as the trust is concerned, the only way is UHSussex.

Rather ominously, there is talk of “appropriate and reasonable next steps” being taken if the actions of some governors do not change. Campaigners believe this could involve the dismissal of some governors.

The council of governors of an FT does, of course, have to approve major transactions including merger or acquisition. It is rare for one to go against the board but the actions taken by NHSI show that there are mechanisms which can be used when this is likely to happen. In a David vs Goliath battle, Goliath usually wins.

A ‘taxing’ balancing act

The last few years have seen a steady stream of organisational mergers in the NHS as the emphasis shifts from competition to collaboration.

How successful such programmes are depends on lots of things, but hospital bosses in Bristol had something of a spanner thrown into their works when the pandemic broke out in earnest about three weeks prior to the creation of University Hospitals Bristol and Weston Foundation Trust.

The contrast between the two organisations that joined together was stark: University Hospitals Bristol FT was twice rated “outstanding” by the Care Quality Commission, while Weston Area Health Trust was rated “requires improvement” amid long-standing workforce and quality problems.

Unsurprisingly, the new trust’s rating is in the middle (“good”), with inspectors continuing to highlight Weston’s workforce problems and a “disconnect” between managers and clinicians.

This disconnect is being attributed to the pandemic, which has understandably diverted much of the senior leadership’s attention.

UHBW CEO Robert Woolley, who retires next spring, told HSJ he believes the CQC picked up on a sense of frustration from staff which has been “pent up” over time, and he said much effort had gone into managers being more “visible” on Weston’s floors.

Mr Woolley also reflected on a broader point about the “hugely taxing” task of maintaining patient safety while simultaneously increasing the amount of partnership work with an increasing number of NHS organisations and other sectors. This will no doubt resonate with many other trust leaders who have to perform a similar balancing act.

While he did not advise against mergers in the present climate, he stressed that trust chiefs contemplating such a change must ensure they fully understand the resources and skills needed – and already in place – before signing the dotted line.