Mergers are seen to be a good thing. Cut duplication, red tape and wasteful tiers of bureaucracy, and get everyone in a geographically distinct locale singing from the same song sheet. But look a little closer.
Managers in the midst of merger planning are potentially designing themselves out of a job. Community groups are fighting a series of bitter house-to-house battles in the heart of England to hang on to cherished old hospitals. Cynics are suggesting that all the upheavals are about is squeezing a few hundred thousand pounds in savings out of the system.
And as if to rub in the futility of it all, many analysts predict there will be another set of mergers along shortly as primary care trusts find they have muscles to flex.
John McClenahan, a fellow in leadership development at the King s Fund, says it is difficult to see what the driving force is behind some mergers.
He says that city-wide mergers of acute and community services are being driven from central government to make savings and cut costs.
Despite the prospect of a decade of New Labour government, Mr McClenahan sees permanent revolution as the only certainty.
In Worcester, a county-wide merger of three acute trusts with community services will see Kidderminster Hospital lose its accident and emergency department to become a community hospital with a minor injuries unit.
Worcester health authority wants to transfer services to a£116m hospital built under the private finance initiative. But patients are saying no. They even won 11 seats on district councils last year in a bid to block the proposals. However, the plans won ministerial approval just before Christmas.
Dr Robert Taylor, chair of Save Kidderminster Hospital Campaign, says he has no problems with the merger itself, as it would prevent three small district general hospitals working in competition. What is contradictory is the reorganisation of the hospitals that means two are saved and one is destroyed.
Harold Musgrove, chair of the merger project team, says: We have got to be patient with Kidderminster people because they have had a hospital for a long time. Our plan is to reconfigure services. We are not taking them away. We will be providing better ambulatory care facilities at Kidderminster and the new PFI hospital will serve the whole of Worcestershire.
In Leicester, plans to turn Glenfield Hospital into a rehabilitation unit as part of a city-wide merger and reconfiguration of three acute trusts - Glenfield Hospital, Leicester Royal Infirmary, and Leicester General Hospital - have met with angry opposition. Ray Flint, a former lord mayor of Leicester, is leading a campaign to prevent Glenfield's new£1m breast care centre and a cardiac intensive care unit being moved. He says the plan is disgraceful, disgusting and unbelievable.
Other parts of the country are bowing to the inevitable. Tiny Bassetlaw Hospital and Community Services trust is set to merge with mighty Doncaster Royal Infirmary and Montagu Hospital trust. Bassetlaw s a small 300-bed hospital and the trust is too small to sustain overheads.
Therefore it had no option but to merge, a Bassetlaw trust spokesperson says.
The community element will be subsumed into a new community mental health trust. The new trust begins work from April 2001 and will also absorb Doncaster Healthcare trust.
In a joint statement, Nigel Clifton, chief executive of Doncaster Royal Infirmary, and Bassetlaw chief executive Munro Donald said: Forming one trust to manage acute services is the logical step on from the partnership. Skills and resources will be combined to improve the quality of care and the health of the people of Bassetlaw and Doncaster .
Ian Barber, Eastern regional officer for health at Unison, accepts the logic behind some mergers but is concerned that many are simply driven by short-term savings or current political dogma.
He cites the example of Anglian Harbours trust. Decisions ere taken behind closed doors and contracts were withdrawn and certain services were divided up amongst other players. All this cost between£2m and£4m and it has never been clear that any of the benefits accrued were in that region because another merger came along before they could materialise.
But plans to merge Southend Community Care Services and Thameside Community Healthcare trusts, where the only job casualties will be at board level, have been welcomed by unions and patients groups.
And a new Suffolk-wide community trust which starts work in April has also been welcomed as a logical way of providing services for a whole geographical area.
A public consultation on reconfiguration proposals for Mount Vernon and Watford Hospitals trust and St Albans and Hemel Hempstead trust showed that local people wanted to keep the status quo. The plans to replace Watford General Hospital and Hemel Hempstead with a PFI site were rejected by health minister John Denham. Merger proposals, revealed at the same time, were greeted with scepticism locally; a ministerial decision is awaited.
Campaigners reacted angrily last year when Kate James, the director of corporate planning for the NHS Executive s London regional office, was parachuted in as project manager across the two trusts to force through unpopular changes .
And the argument that mergers are an evolutionary necessity is also rapidly losing credibility. Evolution implies that this is a valid step towards a perceived long-term goal.
It seems that many mergers are nothing of the sort and simply driven by spurious figures, Mr Barber adds.
Mr McClenahan warns: Senior managers wont know if they have a job for some time.
Alan Yates, chief executive of Stockport Healthcare trust, says a merger between his trust and Stockport Acute Services will have a very limited impact on jobs - many vacancies have been on hold since last summer, many management posts have been filled with temporary staff to avoid job losses. Both trusts have a policy of non-compulsory redundancies. There will be a few job losses - hopefully most will be by natural wastage.
It would be desirable if natural wastage were the order of the day across the NHS. Mr McClenahan is not certain whether the mergers will result in a long line of redundant managers.
Some trusts and health authorities are getting help with out-placing.
Some managers are recognising that they are on limited time and getting out themselves. Anecdotally, they are moving into jobs outside the NHS but in health-related areas.
What about those responsible for pushing mergers forward?
Middle managers, the ones who are driving the merger, actually getting it to work, are not getting the support they need, and indeed in some cases they are designing themselves out of a job.
And chief executives are feeling the pressure of juggling a whole list of priorities, each of which has got a three-line whip attached.
An anonymous letter to HSJ from an angry manager in the middle of discussions about the three-trust merger in Lincolnshire seems to sum up many people s views of the current merger round.
In 2000 it is likely that the trusts will merge. The year after that we will see the demise of community trusts as PCGs become PCTs. I am sure the changes in Lincolnshire are unnecessary in these circumstances. Most staff feel it is change for changes sake and offers no quantifiable improvement in patient care.
If one was cynical one might feel that the changes are mainly to benefit the chief executives career pathway .
Where does regional office come into this? Should they not be asking for justification of such an upheaval when larger re-organisations are just around the corner anyway?
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