All change in a "Mega" Trust

1. All change in a "Mega" Trust Doug Knock Healthcare Library Manager South London Healthcare NHS Trust

2. Overview • Mergers • Theory • In Practice • South London Healthcare NHS Trust • Experience of Library & Knowledge Services • Library Mergers • Opportunity • Threat

3. Mega-Trust? • 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

4. Why merge? • 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

5. Merger mania? • 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)

6. Prescription information • 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

7. South London Healthcare NHS Trust • 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 hospitals Anna Davis10.11.08 NHS mega-trust with £200m debt planned to save hospitals THREE 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

8. Library & Knowledge Services • 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 Similarities Differences

10. A work in progress... Still to come… • Structure • Budget clarification • Income generation / users • Secure line-management • Joint web presence • Streamline services Successes • Journal Rationalisation • Raising standards • Encouraged experience-sharing • New relations with new departments • Coordinated procedures - Wiki

11. Library mergersOpportunity or Threat 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 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

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

13. Any questions? douglas.knock@nhs.net

14. Bibliography 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