Mergers are notoriously tricky affairs and often fail to deliver the expected benefits. But this time last year 49 trusts were working towards one on 1 April 1999 - and most had not received a final decision on their fate as the date approached.
1Anxiety, expectation, anticipation and disbelief were just some of the reactions experienced by staff at Epsom Health Care trust and St Helier trust, which were among those awaiting a ruling. We recognised the need to establish a dedicated team to manage the process of appointments and 'disappointments' effectively. We also needed to communicate honestly, clearly and regularly with all staff. A plan ensuring this would happen was put in place, including merger bulletins, open meetings and focus groups. Key staff were invited to participate in discussions on how clinical and corporate services should be provided in the proposed new trust.
A merger project team was formed - comprising the five executive directors from each trust - and it was determined to ensure that the two organisations were in the best position possible should the new trust be approved.
The impact on staff was a major concern, particularly as significant management cost savings in the region of£1.6m had to be made. Bringing the corporate and clinical management functions of two organisations of very different sizes and cultures together was recognised as a sizeable undertaking, before the negative effect on staff of potential job losses was even considered.
It was anticipated there would be 40-50 job losses out of a total staff of 6,000, but many more staff, potentially 350, would find that their job, and possibly job location, would change. It was clear that this was an undertaking not to be handled 'lightly' or 'wantonly' and we wanted to manage the process openly and support our staff as best we could.
Common policies, including an organisational change policy and an appointments process, were agreed.
A dedicated team, comprising staff from both Epsom and St Helier trusts, was created to manage the merger appointments process, the aim being to appoint staff in a fair and equitable manner to enable the establishment of effective clinical and corporate management as rapidly as possible.
Into the valley of 350 posts at risk rode the merger appointment team with staff to the left of them and staff side representatives to their right. We notified all 350 staff individually that their job might be affected in some way by the proposed merger. They, and their union representatives, were invited to attend one of eight meetings held in different venues to explain the appointment process plans, answer any queries and outline the support mechanisms to be put in place for them.
These meetings were before the merger was confirmed, but 80 per cent of staff who were invited attended one of the sessions. They nicknamed themselves the 'brown envelope people' as a result of the standard issue envelope their invitation arrived in.
It was recognised that failure to invest in the process might lead to greater expense eventually in defending employment tribunals. But since the remit was to reduce costs, a dilemma arose. This was resolved by the merger appointment team successfully bidding for regional funding to help support staff through the process.
It was acknowledged there would be benefits from outsourcing some elements of the support programme, and£40,000 was invested in this, with an external partner chosen through a tendering process. Staff had expressed a need for refresher workshops in CV preparation and interview skills as they wanted to be able to present their skills and abilities in a positive manner, both on paper and in the interviews which they would be required to attend.
This was seen as especially important to many loyal and long-serving staff who had not experienced a job interview for many years. Sixteen CV preparation and interview skills workshops were held, attended by two thirds of the staff, 92 per cent of whom rated them a success.
Activity in the merger appointments unit was demanding and intense, both emotionally and administratively. From June to mid-December 1999 a total of 255 posts were advertised in a bulletin to those staff identified as potentially 'at risk'. Members of the merger appointment team spent hours counselling, coaching and supporting individuals through this process, operating on an 'ever open door' principle as far as possible.
The received wisdom that one partner in a merger is invariably seen as the stronger became a reality, and the fact that early appointments were made more from one trust than the other reinforced this perception.
2Ten months into the merger, the appointments made have been approximately in proportion to the size of the previous two trusts, but the initial 'take-over' view still prevails among the new organisation's legends, despite evidence to the contrary.
Much of the advice and guidance described in Health Ever After - supporting staff through merger and beyond has been put into practice.
2Unfortunately, 38 staff have been made redundant, though 13 of these were voluntary. A total of 34 staff had to move sites, but many more have found the nature of their job has changed. To date there has not been a single formal appeal or grievance, perhaps vindicating the personcentred approach adopted.
The merger appointments unit has received many expressions of appreciation from staff, including those who were not successfully placed.
Many commented on the expert individual counselling and job-search help which they received from the external consultancy.
Our experience endorses the view that mergers usually 'create the most dramatic changes that people will experience at work'.
3Staff experienced pain far more deeply than we had envisaged and that pain is still being felt nearly a year after the merger. This should not be a surprise as experience from the private sector suggests it can take four to five years for a true cultural merger to occur. We believe that the effects of the significant change in structure and culture have been profound and will continue for some time. Nevertheless, the organisation is already being required to come to terms with the next major change.
Many staff have been undertaking merger project management roles in addition to their normal jobs and many feel very weary. In addition, the new trust is now grappling with the opportunities to alter fundamentally the delivery of healthcare within what will be a primary care trust-led service. So we are now asking these same staff to find the reserves to tackle the massive change agenda this requires. This may be too big a hurdle for some to jump straight away.
Epsom and St Helier trust set out to manage the rationalisation of staff in a merging organisation efficiently and effectively. Judged by all quantifiable, and many qualitative, performance measures we have succeeded.
But there have still been job losses, some bitterness and loss of self esteem. This is of course especially true for those who do not have posts in the new organisation but it is also true for many who have. Using all one's sensitivities and interpersonal skills and communicating well can reduce much negativity, but mergers and job losses do not come 'hurt-free'.
We found that staff were often unable to grieve for lost colleagues who had left the organisation without a party or appropriate 'send-off'. It seemed incongruous, somehow, to 'celebrate' the early retirement of a colleague who had in fact been made redundant. We believe we should have found ways to celebrate the service and input of a member of staff leaving so that the sense of loss felt by colleagues could find a natural and healthy outlet. This is a key lesson for next time.
Another challenging requirement was the mismatch between the need to reduce management posts and the expectation that a trust would be able to find suitable alternative employment for senior staff.
In an environment of multiple mergers and nationwide management cost reductions, there were not opportunities available for redeployment in the numbers or at the time needed. We tried our best, but the demographics of the NHS were against us. Only one senior member of staff found employment in a primary care group. We support absolutely the philosophy of redeployment for our skilled and experienced staff. But realities need to be acknowledged and people were not always able to move or travel to work on other sites or in other trusts, for many valid reasons.
We underestimated the significant early retirement and redundancy costs we would incur as a result of the necessary restructuring and centralising of corporate services. We lost several very senior people at board level who were over 50. Some of this restructuring resulted from changing skill-mix requirements.
Although numbers of posts and people overall in the new organisation may not have been markedly dissimilar, the new skill-mix identified was often very different, requiring fewer managers and more staff. It wasn't - and never could have been - a simple numbers approach.
We believed that good, supportive human resources interventions were vital. Although involving staff in the planning and restructuring as we went along was time consuming and taxing, we have found that it was a price worth paying for the quality of outcome.
And if we had rushed the preparatory stages, the process might well have taken even longer and involved appeals and employment tribunals, which we have managed to avoid.
It was certainly true that actions speak louder than words in a merger process. Some vulnerable staff were looking for any chance to avenge their distress, and action that did not meet the new organisation's stated values were - and still are - seized upon by the disgruntled with great glee.
We needed to think and understand what 'valuing' the person meant to each individual and act accordingly. It was as important to recognise individual differences throughout the process of merger as it is in all aspects of our working lives. The 'project team' approach had many benefits and we have therefore taken our learning from this forward.
Also, recognising the ceaseless nature of organisational change we have appointed a human resources professional as part of the strategic development team, to work with staff on individual and career development with the aim of supporting, and thereby helping us to retain, our people through the changes ahead.
We hope our experience may be of use to others, but we do not in any way seek to underestimate the effect a merger has on individual members of staff.
1 Crail M. Bitter pill. HSJ 1999: 109 (5638): 10-11 2 McClenahan J. Howard L, Macknight A. Health Ever After - supporting staff through merger and beyond. London: Health Education Authority, 1999 3Holbeche L. Scary splice. People Management 1998; 15 October 1998: 44-46.
Managing the process of a merger with staff support and job counselling reduces stress. But the experience is not pain-free.
The expectation that senior staff would be found other jobs in the NHS proved unrealistic.
From a total staff of 6,000 there were 38 redundancies, of which 13 were voluntary.
Early retirement and redundancy costs were higher than expected.
l Staff still show signs of distress a year after the merger took place.