TITLE AND AUTHOR

Process and impact of mergers of NHS trusts

Abstract
Objective To study the processes and issues involved in and
impact of mergers between two health trusts A & B in West Yorkshire,
including the resolving of HR issues, providing reward schemes and an
effect on management costs.
Design Cross sectional study involving analytical literature review of
the issues and developing a plan for the merger of the two trusts and
implying a reward scheme which can be successful in satisfying the
workers.
Setting Two trusts (namely A&B) and West Yorkshire.
Main outcome measures Stated and unstated drivers,
and impact of merger on delivery and development of
services, management structures, and staff
recruitment, retention, and morale. Effects of
difference in trust size before and after the merger.
Savings in management costs after merger.
Results Some important drivers for merger are not
publicly stated. Mergers had a negative effect on
delivery of services because of a loss of managerial
focus on services. Planned developments in services
were delayed by at least 18 months. Trusts' larger sizes
after mergers had unintended negative consequences,
as well as predicted advantages. The tendency for one
trust's management team to dominate over the other
resulted in tension. No improvement in recruitment
or retention of clinical and managerial staff was
reported. Perceived differences in organisational
culture were an important barrier to bringing
together the two organizations. Two years after
merger, merged trusts had not achieved the objective
of saving £500 000 a year in management costs.
Conclusions Important unintended consequences
need to be accounted for when mergers are planned.
Mergers can cause considerable disruptions to
services, and require greater management support
than previously acknowledged. Other organizations
undergoing restructuring, such as primary care
groups developing into primary care trusts and health
authorities merging into strategic health authorities,
should take these findings into account.

TRUST A TRUST B
*This trust has a decentralized structure with This has a centralized structure.It
two independent departments with respective has many small departments and the
directors for each. Managers have less authority.

*Medical staff and managers have no intimate Here, medical staff and managers
relationship between them. Maintain good intimacy between
each other.

*The HR department has less tasks to accompl- All functions including training and
ish, hence it can perform its duties well. Confidential information and
employee development is managed
by the HR department.

*There are separate line managers to take care Personal files are held by the HR.
of personal files.

As the attitudes and culture of the two trusts are entirely different, most of the staff are
happy with the present conditions and they would be reluctant to work in case there is a
change in the way things are operating now. Our major objective is employee satisfaction
which needs to be achieved in case the HR and finance functions have to be reorganized
My major aim in the essay is to develop an analytical literature review indicating the
issues that the organization could expect as a result of the merger of the two contradictory
cultures of the health trusts named A & B. Then I am going to provide a vivid
plan for merging the two cultures indicating where one can expect lines of resistance to
occur and demonstrating how I would abate this resistance. Finally, I am going to provide
a reward scheme for the Trust that reflects the new expectations for the workers and
explain how this scheme will act as a part of the change management process to provide
new lines of influence and support.

Employee motivation strategy has long been an important aspect in commercial business
as companies seek to get the very best out of their staff, by incentivising them to make
the business more profitable. Let it be small incentive schemes like vouchers and gift
cards also prove successful. Talking about a health trust, as most of the services provided
to the patients are free of cost, there might be political problems arising in case of funds
necessary to implement reward schemes. A major reward scheme which can not only
reach the expectations of the workers but can also enlighten them with joy is a massive
hike in their salaries. So here I suggest the Cash Bonus Reward Scheme which can
actually have two parts a) a periodic hike in salary and b) a sudden hike like a gift or
reward. The option best suitable in a situation like this is the latter one. Hence, there
needs to be a sudden hike in a salary for each and every worker and a promise to be made
that there will be periodic hikes in the later months. Another major problem mentioned
was that the workers might be reluctant to move to different sites. So the new site needs
to be a better place to be in and a better environment needs to be provided. We can place
a canteen on every floor of the new building with good staff discounts like around 30%
on the weekdays and 40% on the weekends. Employee satisfaction is sometimes not just
restricted to the employee but to his family too like wives, girlfriends and children. So we
will provide gift vouchers of supermarkets or designer shops to gain impression of their
families too. The cheapest form of reward that can be provided is ‘time off’. It is cost-
effective but not always successful and it is difficult to schedule it. As our situation is in
such a way that more the reward schemes, more the workers will be satisfied and will
perform well. Time-off means nothing but offering leave to the employees whenever they
are in need or when they need a long weekend like an off on a Friday or a Monday, we
need to take that into consideration and schedule it in. Benefits to staff of mergers
includes improved systems of clinical supervision, more coherent
professional management, and the advantages of programmes of
appraisals, training, and career development that have been
implemented.

Merging of any two organizations is always a challenging task. After the board level
discussions, there have been many HR issues yet to be resolved. The two trusts still work
as two networks or two entirely different groups with different sets of policies and
standards. The major issues that might come to light can be the delivery and development
of services, management structures, retention and morale. These
include disruption of services as a direct consequence of mergers,
diseconomies of scale, and problems with staffing, service integration,
systems integration, and
working practices, as well as issues of equity and access to services. As
there should be minimum disruption to the status quo, there might be a few job-cuts or
new staff recruitment. The ones who lose their jobs might have to be compensated.
Hence, our priority is to specify jobs to the ones who are already working, put them in
their respective genres and treat them sensitively so as to create an atmosphere of
confidence and trust and match the current situation to the environment they already
enjoyed or provide a much better environment. What is needed in such situations is the
calm appraisal of the situation. The new staff which will be recruited need to be highly
skillful in their respective fields so as to alleviate managerial defects in the future.
The merging of two trusts might have a negative impact on the delivery and
development of services. As Trust A has two big departments (surgery and medicine) and
Trust B has numerous small department, it can be difficult to give equal importance to all
departments until and unless each of them have efficient managers to look after each.
Clinical and managerial staff, however, emphasised the stress caused
by the perceived imposed uncertainties and changes and the increase
in workload associated with the process of merger.