Doug KnockHealthcare Library Manager

South London Healthcare NHS Trust

Mergers◦ Theory ◦ In Practice

South London Healthcare NHS Trust◦ Experience of Library & Knowledge Services

Library Mergers ◦ Opportunity◦ Threat

What is a ‘Mega-Trust’? Also know as a ‘super’

trust or a ‘super-hospital’

Fears that ‘superhospital’ merger will threaten patient services

NHS mega-trust with £200m debt planned to save hospitals

Hospitals merger to

cost 1,200 jobs

The million dollar question (literally)◦ Reduce management costs◦ Reduce operational costs◦ Reduce surplus capacity / rationalise services◦ Financial viability for smaller organisations

Improve patient care◦ Specialised units◦ Improved training / staff retention

Service re-configuration

17 mergers took place between 1991 and 1997

Between 1997 and 2001, 99 Trust mergers took place (Fulop et al., 2002)

460 respondents to a survey in 2003◦ 23% Exploring / proposing a merger◦ 7% Actively involved in a merger◦ 6.5% Being forced into a merger◦ 9.5% Completed a merger◦ 23% Did not anticipate a merger(Cereste, Doherty, Travers, 2003)

Warning: Can take a lot longer and require more support than anticipated

Warning: Can have significant impact on Staff morale

Do not take Merger tonic if currently taking other prescriptions including take-over tablets.

Merger tonic should always be taken through choice rather than compulsion.

Merger tonic should only be taken in combination with clear goals, open communication and full commitment.

Common side-effects Significant short-term impact on service delivery Financial cuts Paranoia (it’s a takeover) Loss of management direction Audio-hallucinations (Chinese Whispers) Headache, shivers, cold sweats

Three Acute Trusts / Bromley Hospitals / Queen Elizabeth / Queen Mary’s merger April 2009.

Covers over a million inhabitants in London Boroughs of Bexley, Bromley and Greenwich. Very diverse population.

Three site libraries 11 members of staff / 4 qualified

librarians◦ 2 Library Managers◦ 2 Information Skills Trainers◦ 2 Senior Library Assistants◦ 5 Library Assistants

15,000 books 47 PC terminals Over 4,000 registered users

NHS mega-trust with £200m debt planned to save hospitalsAnna Davis10.11.08

NHS mega-trust with £200m debt planned to save hospitalsTHREE debt-ridden NHS trusts in the capital are set to merge into one mega-trust with a combined debt of £200 million, it emerged today. In a last-ditch effort to survive, the move would see the three south-east London trusts pool resources and cut costs. Bromley Hospitals, Queen Mary's Sidcup and Queen Elizabeth trusts will today begin consulting staff on the proposed merger. It could save the three organisations £2.5million immediately but there are fears the move would see services centralised within the proposed mega-trust. There is also concern over the distance between the hospitals in the new organisation - 12 miles separate hospitals in Bromley from the Queen Elizabeth hospital in Woolwich.

http://www.thisislondon.co.uk/standard/article-23584306-nhs-mega-trust-with-200m-debt-planned-to-save-hospitals.do ; Evening Standard 10/11/2008

Similarities Differences

Shared LMS / cataloguing policies

Communal OPAC / book sharing within consortium

Target audience Same suppliers (books

/ journals / databases)

Staffing levels / Line-management

Budget (resources / facilities)

IT facilities Fines / loans Procedures / forms Site subject specialism Culture

Successes Journal

Rationalisation Raising standards Encouraged

experience-sharing New relations with

new departments Coordinated

procedures - Wiki

Still to come… Structure Budget clarification Income

generation / users Secure line-

management Joint web presence Streamline

services

Opportunity Service review to

ensure alignment within new organisation

Build on existing strengths ◦ Greater purchasing

power◦ Rationalisation

New links which fit in with new objectives

Threat Loss of budget

◦ Quality / service◦ Staff

Uncertainty within organisation

Loss of ‘champions’ Less emphasis / time

for learning within a restructuring organisation

Library low on list of priorities

Communication Staff involvement Be prepared to compromise Get your statistics ready Consider cost-saving / income generation Get in there early...

douglas.knock@nhs.net

Cereste M; Doherty NF; Travers CJ An investigation into the level and impact of merger activity amongst hospitals in the UK's National Health. Journal of Health Organization & Management, 2003, vol. 17p. 6-24)

Cortvriend, P Change management of mergers: the impact on NHS staff and their psychological contracts. Health Services Management Research, 2004, vol 17 p.177-187

Fulop, N. et al. Process and impact of mergers of NHS trusts: multicentre case study and management cost analysis. BMJ, 2002, issue 7358 p.246-249

Garside P; Evidence-based mergers BMJ , 1999 vol 318 p.345-6

Goddard M, Ferguson B. Mergers in the NHS: made in heaven or marriages of convenience. London: Nuffield, 1997