Two things are important in mergers: clear goals, clearly communicated

The NHS seems to be in the grips of “merger mania.” Why is this happening and why now? More importantly, on what basis do we judge whether the merger of two or more NHS organisations is successful and is there an evidence base on how to manage them?

Seventeen mergers of NHS trusts took place in England in 1991-7.1 The cycle of trust establishment and merger activity follows the NHS financial year. Twenty three mergers came into effect from 1 April 1998, and ministers are considering further proposals for April 1999. In Scotland's current “reconfiguration” the number of trusts is planned to reduce from 47 to 26, and in Wales 26 trusts will be reconfigured into 16 by April 1999. The government sees these mergers as “evidence of a new cooperative culture developing inside the NHS.” Laudably the key test that will be applied in judging the merits of merger proposals will be whether they improve patient care. All will also have to lead to proved reductions in bureaucracy.2

Mergers occur in mature industries because of trends such as globalisation, increased competitiveness, and government deregulation policies: thus many examples …