Merging hospitals can benefit everybody

BMJ 1996; 312 doi: (Published 20 January 1996) Cite this as: BMJ 1996;312:144

Mr James Thompson, surgeon and clinical director of St Mark's Hospital for Intestinal and Colorectal Disorders, spends a lot of his time assuring people that the journey from central London to Northwick Park in northwest London is not difficult. This matters to him because he and his hospital have just moved from the city to form part of Northwick Park Hospital—and the distance from central London (30 minutes by tube) is perhaps the only drawback of the move.

Nearly three years ago this column wrote about how St Mark's Hospital, unlike almost all the London hospitals slated for merger or moving, was contemplating the prospect of a move with some enthusiasm. It was due to form a joint trust with Northwick Park, a large district general hospital, and looking forward to moving from east London to refurbished accommodation there. That move happened last July—and seems to have exceeded everyone's expectations. It has moved from a much loved but inadequate and run down building in east London to newly refurbished, purpose built, and spacious accommodation at Northwick Park. It has the opportunity to work with other specialties in a way not possible as a single specialty hospital; it has immediate access to intensive care beds (it shares theatres, recovery, and the intensive therapy unit with the rest of the hospital); and it has the opportunity to expand its secondary work by becoming the department of coloproctology for the whole trust. It has also gained from the management skills of the bigger trust, and Mr Thompson praises the way that the trust's management oversaw the project and generally managed the change.

A shop within a shop is how one clinician at Northwick Park described the arrangement. St Mark's has managed to preserve its identity: it is embodied in the name of the joint trust—Northwick Park and St Mark's Trust; it has its own separate entrance within the sprawling Northwick Park site; all its facilities—outpatients, wards, investigation facilities, and research space—are together in the same block; it forms a directorate within the trust; and it manages its own contracts (particularly important for a hospital whose work consists mainly of tertiary referrals).

What Northwick Park has gained is perhaps less obvious. It was designed 25 years ago as a place where the work of a district general hospital could be integrated with clinical research into common conditions. So several of its wards and laboratories were built with generous space for research. Many argue that the research never integrated with the clinical work in the way intended, and some years ago the Medical Research Council closed the Clinical Research Centre. Since then Northwick Park has been looking for someone to take over the space—and has made offers to several vulnerable single specialty hospitals around London. One has been that the research space, if not filled with NHS services, might have been auctioned off to the highest bidder.

Now it has a occupant that not only fills the space but also contributes to and complements its existing research units—and increases its opportunity to fulfil its original purpose as a research hospital. It has also gained a brand new endoscopy suite within the St Mark's unit, which serves the whole hospital.

So what are the lessons for others contemplating moves and mergers? St Mark's had the foresight to realise early on that, under the right conditions, it had more to gain than lose from a move and a merger. It then set energetically about trying to ensure the right conditions. It rejected a merger with its nearby teaching hospital and sought instead a partner who also had something to gain from the merger and would allow it to preserve its identity. It was what the management jargon calls a “win-win” solution. And such a solution in London's troubled health service swiftly attracted both approval and funds.—JANE SMITH, BMJ

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