Will the policy of acquisition help create sustainable NHS organisations so that accessible and stable health services for local people continue to be provided? The answer is yes and no.
The acquisition of ‘challenged’ trusts will, in the majority of cases, offer a quick managerial fix, thereby returning stability to the organisation and local health services. But it won’t necessarily create strategically sustainable services and the operational problems that precipitated acquisition in the first place may well reoccur. Furthermore, many small and medium size foundation trusts will also encounter difficulties as the economic challenges increase. Consequently, many FTs will increasingly find themselves having to make decisions about their own organisational futures.
The challenges of maintaining income, controlling costs, responding to (anticipated) tougher commissioners and rising inflation will test all providers. Some will succeed and some will fail whilst others will muddle through. Those with some insight will seek mutually beneficial relationships, perhaps trying to agree complex arrangements for sharing income and covering costs without necessarily reducing them. But true success will lie with what will be a smaller number of visionary providers, for these are the ones who recognise the need to not just slavishly pursue acquisition but consider truly strategic mergers.
These visionaries will recognise the need to reinvent their organisation in another form in order to protect services and staff. For them it will be not just about creating critical mass to survive economic pressures but creating a truly strategic solution. Importantly, they will also recognise the need to dissolve their organisation in order to create something new. And this would then need public consultation on the proposed new organisation, which perhaps is no bad thing in the current climate of major concern over public services.
To pursue a strategic merger approach means taking a wider helicopter, rather than parochial opportunistic, view and seeking through merger the best solution that will create longer-term strategic sustainability. Perversely, and I’ll mention this quietly, it almost requires a top-down planning approach. I can hear the groans now across the NHS but perhaps sufficient time has now elapsed for a revisionist appraisal? After all, if you accept the view that a market-based competitive approach won’t fix everything do we have any plan B’s? No, I didn’t think so either.
Of course the NHS is used to quick managerial fixes, required in many cases to maintain services and assuage local political and consumer pressures. And of course the quick-fix approach also reflects government short-termism with the desire to sort issues within a single parliament. But this is not always right - taking the more considered strategic approach may be harder but it is likely to result in more sustainable public services.