Merging up to 30 failing hospitals will not bring them back to clinical and financial stability. The impact of a merger is not sufficient to change mindsets or structures.

The warning comes in a report ‘Tackling failing NHS hospitals’ from Reform, the independent think tank.

Research into failing hospitals revealed that past mergers between NHS organisations have not worked. When underperforming hospitals merge with other underperforming hospitals they fail because the mergers simply create larger underperforming hospitals. The report says that it is possible to develop a better hospital from the core of a failing one, but this will only be achieved through a profound and systemic change to the structure of the hospital. And the surest way of achieving this, learning from recent NHS history, is not a merger of equals, but the process whereby a very successful hospital takes over a failing one.

Takeovers only work when the acquiring organisation changes the business model and the working practices of the staff. Unless there is a threat of closure, the leadership of the organisation does not face up to the change. If every failing hospital believes that its local elected politicians will stop its closure, then they will avoid going through the hard business of change. The organisational turmoil of a takeover is a necessary part of change.

The report argues that chains of hospitals run by the best NHS Foundation Trusts and private companies should develop centres of clinical excellence with strong brands. They would cut costs and improve the quality of the care delivered to patients, spreading best practice and achieving economies of scale.