Staff play a big role in delivering merger success

Getting to the point of a merger between two NHS trusts is never going to be a piece of cake – and what happens next is the real leadership challenge.

So says Peter Worthington, chair of the newly constituted London North West Healthcare Trust.

Formed on 1 October, the new body brings together Ealing Hospital Trust and North West London Hospitals Trust, providing health services for a population of 850,000 patients across Brent, Ealing and Harrow.

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The making of a merger

“This is something that has been three or four years in the making,” explains Mr Worthington.

“It’s an exciting merger that has created one of the biggest integrated care trusts in England, which puts the organisation in a stronger position to support Shaping a Healthier Future [the programme to improve NHS services for the 2 million people living in north west London].

“What happens next as we deliver our plans is tremendously important for the trust, for the staff, and, of course, for the patients we’re serving.”

The new organisation has four hospitals, three community hospitals, more than 8,000 staff, including some 2,300 in the community; it has 21 sites across a culturally diverse stretch of the capital.

Inevitably, the run-up to the merger was challenging, particularly when you factor in a history of financial deficits and a pressing need for service reconfiguration. Although there was a general recognition that change was needed – and that merging would put services on a more sustainable footing, clinically and financially – getting staff fully engaged with the changes was the real task.

Support from the local health economy and on a national level has been important, he says.

‘The merger has been about cultural leadership, getting people to a point of emotional commitment’

“We’ve been given great support from our local clinical commissioning groups, the NHS Trust Development Authority and NHS England. There are plenty of obstacles ahead, but I think we’re in a really positive environment locally, and working collaboratively with our commissioners to support the implementation of [Sharing a Healthier Future] for the benefit of patients across north west London.

“We’re not starting from fresh – this hasn’t been a sudden process. It’s been about cultural leadership, getting people to a point of emotional commitment and operational readiness.”

Engage with staff at every stage

According to chief executive David McVittie, who will step down around the end of the current financial year, getting meaningful staff buy-in was a crucial component.

His leadership approach involved being visible, talking to people honestly, and involving staff at every stage. This was achieved by creating a narrative, rather than a definitive plan. “We didn’t start with a definitive blueprint,” he says. “We wanted to take people with us, so we all had to be engaged in finding the way forward collectively.”

‘Staff know what the problems are and what needs to be done to sort things out’

Groups of clinicians and senior managers from across the organisations were encouraged to work together to consider the future shape of services. This chimes with Mr Worthington’s leadership philosophy of valuing the perspective of staff, particularly clinicians.

“I remember attending an NHS event and hearing [former Marks & Spencer chief executive] Sir Stuart Rose talking about how he was trying to help the NHS change strategies,” he says.

“He was saying that he would go to hospitals and providers and ask staff on the floor what they thought could be done to make things better; and that the solution was usually found within the organisation – the real key to success was to unlock that.

“The staff know what the problems are and what needs to be done to sort things out. Leadership involves giving people the kind of open environment where they feel they can engage and take things forward.”

From day one

As well as integration groups, staff were encouraged to talk to and work with people from different parts of the new organisation, even doing shifts on different sites.

This helped ensure people knew each other, and that they had an appreciation of where each other was coming from.

‘Staff need to accept a role in delivering the future’

Making sure systems worked smoothly from day one was also important, including the new organisation’s website and IT.

Mr Worthington, whose background is in the oil and gas industry (he is chief executive of Midway Resources International, which works across Africa), says there are commonalities between that sector and the NHS.

“Oil and gas is high risk, high reward, so different from the NHS,” he says. “But one commonality is that staff need to accept a role in delivering the future. The NHS actually provides freedom for people to have a substantial degree of control over their own future, the hospital’s future and the future for patients. It’s up to leaders to foster this.”