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by Nikos Kefis, Senior HR Consulting Manager, NHS Shared Business Services. |
The spate of NHS trust mergers signals that integration of operations and services remain top of the NHS’s agenda. Mergers do, however, come with people challenges. HR teams should, therefore, ensure they have the right foundations in place and well prepped for Day 1. before progressing integration plans.
Merger.
The spate of NHS trust mergers signals that integration of operations and services remain top of the NHS’s agenda:
- In January 2025, the North Middlesex University Hospital Trust merged into the Royal Free London NHS Foundation Trust
- Q4 of 2024 alone saw three mergers come to fruition, including the creation of North London NHS Foundation Trust – the consolidation of two mental health trusts, Barnet, Enfield and Haringey NHS Trust and Camden and Islington NHS Foundation Trust (Mergers and acquisitions – NHS England Digital)
- Furthermore, five Adult Acute and Specialist NHS Trusts in Liverpool have agreed to integrate their Trusts into a city-wide hospital Group, the NHS University Hospitals of Liverpool Group (UHLG) by 2028
Merging can bring several benefits:
- Improved Integration of Services:
Better integration of hospital and community-based services, physical and mental health services, and social care. This integration can enhance the coordination and delivery of care, leading to a more holistic approach to patient health - Resource Optimisation:
Optimisation of resources, like staff, technology and infrastructure through more efficient use, reducing duplication and waste, and lowering operational costs - Enhanced Patient Experience:
Integration of services through mergers can lead to a more seamless patient experience. Patients may benefit from improved access to care, reduced waiting times and more consistent and coordinated treatment plans - Improved Financial Stability:
Pooling of resources and budgets can offer greater financial stability and provide a stronger financial foundation to invest in new technologies, facilities and services that improve patient care - Innovation and Best Practices:
Mergers can facilitate the sharing of best practice and innovative approaches across the merged entities, leading to improved clinical outcomes and the adoption of more effective and efficient care models - Enhanced Workforce Development:
A merged organisation can offer more comprehensive training and development opportunities, and support the continuous professional development of healthcare staff, ensuring they are equipped with the latest skills and knowledge
Mergers, however, do come with people challenges: Our experience shows that:
- Highly talented employees are often at most risk of leaving, and if they are not engaged, they will be the first to leave during a merger or an acquisition
- The uncertainty and stress caused by a merger can result in a decrease in morale, leading to disengagement, absenteeism or higher levels of stress-related sickness
- Staff may feel uncertain about their future and without the appropriate communication, may believe a merger will lead to job losses or downsizing
- Mergers can significantly impact leadership teams as new leadership structures are often implemented to streamline decision-making processes
- NHS organisations often take several years to fully integrate systems, processes and policies. During this period, employees in merged organisations will need to undergo training or reskilling initiatives to ensure they are able to work in the newly integrated environment
- Following a merger, some NHS trusts experience challenges in attracting new staff, particularly when there is uncertainty about the future direction of the organisation
Preparing for Day 1
HR teams should, therefore, ensure they have the right foundations in place, before progressing integration plans:
Operating model and organisation design
Having the right operating model and organisation design in place from Day 1 can help trusts:
- Mitigate Day 1 risks
- Secure continuity of operations · Proactively manage talent flight risk
- Communicate changes in roles and reporting relationships
- Minimise disruption caused by execution of organisational decisions
Governance
A high performing office programme to drive all aspects of a merger i.e. planning, operating model, organisation, synergies, communication and culture, is necessary to ensure alignment and consistency across all workstreams. It can facilitate timely decision-making and issue resolution; manage interdependencies, identify critical risks and prevent disruption of normal course of operations e.g. employee attrition.
Communications and change management
Operating model and process change needs to be managed carefully and communicated clearly. A robust change & comms plan in place can assist the merging NHS trusts to:
- Ensure higher ‘adoption rates
- Mitigate employee attrition
- Keep all stakeholders informed
- Act as a catalyst for achieving desired culture
HR functional integration and alignment with the talent agenda
HR’s role in the overall success of the merger of the operations of two or more trusts is integral when it comes to preparing the new organisation for the Day 1 of its operations and beyond. In particular, HR should be able to proactively act and:
- Create the HR operating model
- Ensure availability and integrity of HR systems and reporting
- Review, revise or create HR processes and ensure consistency and harmonisation across all the trusts · Ensure payroll is setup appropriately
- Ensure compliance with all employment law regulations (e.g. staff consultations where applicable)
- Execute on culture integration activities
- Onboard/offboard resources as needed
- Provide organisation design, leadership alignment and selection support
- Capitalise on opportunities to gain or retain the best talent required to drive the new integrated trust forward
- Aggregate employee data for the involved trusts (HR data migration)
Want to know more?
NHS Shared Business Services’ (NHS SBS) HR consultancy services are designed to assist the NHS throughout the workforce transformation, merger and restructure journey, delivering efficiency and productivity savings. Contact: Nikos.Kefis@nhs.net
