NHS trusts should focus on the reasons for collaboration

NHS Collaboration: focus on the reasons

The most effective method of healthcare collaboration will be determined by the problem that is being addressed and the benefits that are being sought



KPMG in the UK


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Three Ants on Leaf

NHS organisations are grappling with the increasing needs and expectations of patients, advances in technology and new thinking around clinical practice. One response from trusts has been to collaborate with their peers but what is the best way of doing so?

Roberta Carter argues that care providers must first focus on why they need to collaborate, and only then examine what form that should take.

NHS trusts have a much greater chance of collaborating successfully if they remember why they are working together, and only then worry about how to structure the new entity.

Too many NHS healthcare mergers were failures in the 1990s for that very reason. In many cases, hospital administrators simply grafted together two management structures, and only later brought together back-office functions. In some cases, the divisions between distinct front-line services remain visible to this day.

These were often publicly-mandated mergers, motivated for political reasons. By contrast, today’s successful collaborations have a compelling clinical rationale at their core, underpinned by commercial and financial rigour.

I’m glad to say an increasing number of collaborating trusts are getting the message - perhaps because they have to. NHS staff are working under far greater pressure now than 20 years ago. Budgets are stretched and the need to be more efficient and streamlined is more urgent. The logic of collaboration, and the need to make it a success, is compelling.

In the successful deals I’ve worked on, in both the public and private sector, the strategic rationale has always been clear.

The NHS is one of the sacred cows of British politics and any change will inevitably face entrenched positions, such as political opposition and scepticism from clinicians who may not understand the benefits for patients. We all instinctively oppose change and want to protect local services. Even as hundreds suffered poor care at the Mid Staffordshire trust, people were waving ‘Save Our Hospital’ banners outside. Leaders must make sure they properly articulate why collaboration is in the public interest and ensure they have backing from clinicians.

Once trusts have decided to collaborate, they need to do so whole-heartedly and at every level. For that reason I see mergers – rather than joint ventures or alliances – as the most successful form of collaboration.

Joint ventures might endure for decades, but neither party is fully committed. The merger model is far more comprehensive and the best way to achieve big transformational change. Mergers offer organisations synergies, so duplication and overlap are stripped out. More importantly, they bring together services that might previously have been provided by a number of organisations, giving doctors and nurses greater consistency and control across patient pathways.

Whatever the form of collaboration, its success depends on integrating information and ensuring all clinicians have complete access to their patients’ holistic care plans and records. While investing in IT might seem less exciting than M&A, it is nonetheless a fundamental enabler for efficiency and patient safety. It also makes it easier to move activity out of hospitals and into the community, the home, a GP surgery or elsewhere.

The NHS is already very skilled at collaborating across boundaries such as the Academic Health Science Centres and cancer networks. But if trusts are trying to drive transformational change then a merger will produce results much faster. In an environment of ever greater demand and smaller budgets, properly thought through collaboration is essential to deliver higher-quality healthcare.

This article represents the views of the author only, and does not necessarily represent the views or professional advice of KPMG in the UK.

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