Hospital mergers may be painful but have positive aspects too

EDITOR—Most of us would agree with Harvey's comments in her personal view about the problems of hospital mergers.1 A merger is more like a divorce than a marriage. It introduces vulnerabilities, sensitivities, suspicion, and redirections that often seem inappropriate.

The developing paranoia that Harvey expresses—concerning the perceived low morale and poor standards of the interloping hospital—is only too common. It is overcome by communication and joint decision taking, which, in itself, is extremely difficult, not only because of the separation of the units but also because of the lack of time in one's clinical practice.

There is, though, a positive side to a merger. The larger population that we serve allows a more efficient use of resources, particularly in smaller specialties. Merged departments allow a more efficient use of junior hospital doctors, especially specialist registrars; this is a bonus in view of both the European directive to reduce their hours and the reduction in Calman numbers. The Royal College of Obstetricians and Gynaecologists has considered the increasing risk in obstetric practice, litigation, governance, and training of junior hospital doctors.2 In addition it is implementing standards that include 40 hours a week of consultant presence on labour wards and a delivery rate per consultant that falls from the national yearly average of 543 to 300.2

The surgical process of the merger might be painful but the improved health care of patients and quality of practice should make it worth while.