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Human Resource Development International

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An evaluation of the effects of a National Health Service Trust merger on the learning and development of staff
Sheri Goddard & Adam Palmer
a b a b

Director Sheri Goddard (Consultancy) Ltd & GPW Management Ltd, Crawley, UK Senior Lecturer, HRM, Winchester Business School, University of Winchester, UK

Available online: 22 Oct 2010

To cite this article: Sheri Goddard & Adam Palmer (2010): An evaluation of the effects of a National Health Service Trust merger on the learning and development of staff, Human Resource Development International, 13:5, 557-573 To link to this article: http://dx.doi.org/10.1080/13678868.2010.520480

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Human Resource Development International Vol. 13, No. 5, November 2010, 557573

An evaluation of the eects of a National Health Service Trust merger on the learning and development of sta
Sheri Goddarda and Adam Palmerb*
Director Sheri Goddard (Consultancy) Ltd & GPW Management Ltd, Crawley, UK; bSenior Lecturer, HRM, Winchester Business School, University of Winchester, UK (Received 6 April 2010; nal version received 25 August 2010)
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a

Although mergers are increasingly common amongst National Health Trusts in the UK there is limited research on how National Health Service (NHS) mergers inuence the learning and development of sta. This paper bridges the gap in the literature, through a case-study of a recent NHS Trust merger. It gives an account of the delivery of human resource development (HRD) post merger as seen through the eyes of sta from across the merged organization. The data were obtained from 21 unstructured interviews, nine group discussions, two focus group discussions and a form of micro-ethnography. In addition, quantitative data were used for triangulation purposes. Findings show that power dierentials, cultural clashes and unequal access to training and development amongst sta have resulted in hostility towards the new organization. However, the strong management structures for professional members of sta have facilitated knowledge exchange across boundaries in the merged organization. The paper concludes by suggesting that without senior managers dealing with cultural issues and inequitable development opportunities, a number of unintended consequences of the merger are likely to occur. Keywords: learning and development; merger, organizational change; NHS

The National Health Service (NHS) Trusts in the United Kingdom (UK) are public sector corporations set up to manage health services within a designated geographical area. Over recent years the British government has put the NHS under increasing pressure to be more accountable to stakeholders, to operate more eciently and, at the same time, to increase its eectiveness (Cabinet Oce 1999). In the private sector, a common response to these needs is to merge with another organization, as the benets (such as, a reduction in costs by removing duplication) are thought to outweigh the costs (Stanwick and Stanwick 2001). This notion has also spread to the NHS where, as a consequence, the merging of Trusts is a growing response to these pressures. As Cartwright and Schoenberg (2006) note, however, despite their attractiveness, there remains a number of diculties which prohibits mergers from being regarded as a success. Leading up to a merger, many employees

*Corresponding author. Email: Adam.Palmer@winchester.ac.uk

ISSN 1367-8868 print/ISSN 1469-8374 online 2010 Taylor & Francis DOI: 10.1080/13678868.2010.520480 http://www.informaworld.com

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experience stress and anxiety over the security of their jobs. After the merger, the organizational culture of organizations, its values, beliefs and traditions, can create culture clashes, which are one of the major causes of merger failures (Price Waterhouse Cooper quoted in Turner 2000; Boxall and Purcell 2003, 221). Whilst the research on the eects of mergers in the private sector is dense (Cartwright and Schoenberg 2006), it remains undeveloped in the public sector and specically with regards to the NHS. Present studies on NHS mergers tend to focus on either the eect of organizations going through a merger or the post merger eects on services, job satisfaction and sta turnover (Fulop et al. 2002; Currie and Suhomlinova 2006). Similarly research in the private sector has concentrated on how learning is accumulated about the acquisition process and the relationship between dierent forms of learning and successful organizational performance post merger (Barkema and Schijven 2008). One area that has not been addressed by the literature is the eect NHS mergers have on workforce development. This area is worthy of consideration because in the knowledge society, employees are thought to represent an organizations competitive advantage (Mullins 2007). If organizations wish to succeed, they need to draw the most out of their human capital (Boxall and Purcell 2003, p. 221). Within the NHS, the core competencies of professional sta are critical to the provision of the service and, less acknowledged, the non-clinical sta groups who support and facilitate the service. The importance of honouring employees expectations and needs, the psychological contract (CIPD 2009), is the dierence between increased or lowered levels of commitment and satisfaction. This paper, through a case-study of a merger between NHS Trusts in the south of England, evaluates its success with regards to training and development. The research question is: what impact has the merger had on the delivery of learning and development within the new structure? Within this overarching question the research is concerned with investigating whether the anticipated benets of pooling resources and economies of scale have been realised. The paper rst identies the limited literature available to inform research and management practice in this area bearing in mind the higher level HRD strategies within the UKs NHS. Subsequently, it oers a contribution to this under researched area through the responses of those involved and aected by the provision of learning and development post merger. Literature review and policy context Studies on the impact, implications and consequences for HRD in merged organizations are scarce (Jeris, Johnson, and Anthony 2002). Furthermore research specically on the eects that NHS mergers have on employees and workforce development is even more limited. However, knowledge sharing has increasingly become a focus within the NHS with the need to gain eective management of knowledge across professional and organizational boundaries to improve services. Qualitative research carried out with 29 medical professors, general managers, consultants and junior clinicians, revealed eorts to cross boundaries (Currie and Suhomlinova 2006, 30). Due to power dierentials arising from the work of senior medical clinicians, it was found there was not always a willingness to share information, therefore full disclosure of information (other than condential material) was not always oered. The research recommended developing new policies to alleviate power struggles and allow knowledge sharing across boundaries. The sharing of knowledge across boundaries is important in developing a learning

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organization (Swart et al. 2005, 49) in that it is benecial to systematic problemsolving, experimentation and reective learning from working practices. However, the ecient transfer of knowledge across organizational barriers is problematic, particularly after de-layering and merging organizations (Swart et al 2005, 50). Steele and Osborne (1983 quoted in Napier 1989, 281), suggest merged companies should standardize or adopt new employee appraisal systems to create consistent work expectations. Therefore an NHS merger should in theory benet from strategies that support HRD through the common use of the NHS Agenda for Changes Knowledge and Skills Framework (KSF) introduced in 2004 as part of a new pay system (McBride and Mustchin 2007, 1611). The KSF provides a fair and objective framework on which to base review and development and identies the knowledge and skills required for each post (DH 2004). All NHS jobs (except doctors, dentists and directors) are matched to one of nine pay bands, with junior roles falling within pay bands 14, supervisory/specialist roles at pay bands 56 and senior roles at pay bands 79. Therefore the Agenda for Change and KSF should form a common basis for merged Trusts to create consistent working practices. However, a signicant barrier may be the interpretation and application of the KSF and the associated training, which can dier between NHS Trusts. NHS organizations spend over 4 billion each year on formal education, training and development, although the majority of the money is spent on registered sta with support sta and part time sta having the least access to training opportunities (McBride and Mustchin 2007, 1612). In 2000, the NHS Plan gave support to training employees without formal qualications, allowing people to improve their career opportunities by obtaining National Vocational Qualications (NVQs) as part of the Skills Escalator (DH 2008; McBride and Mustchin 2007, 1612). However, in practice, many Trusts have failed to fully support NVQ studies or access NHS Learning Account funds for employees. Due to nancial constraints, training budgets for support sta had been cut or frozen (McBride and Mustchin 2007, 16223). Health support workers have even less access to training than clerical and administrative sta (Aldridge et al. 2005). In 2006, Professor Bob Fryer, National Director for Widening Participation in Learning, was highly critical of the lack of priority given to learning in the NHS. Fryer raised concerns that over half a million NHS non-professional employees had two or less training days over the previous 12 month period and a further quarter of a million NHS employees had received no training (Brockett 2006, 13). In research carried out on black and ethnic minority (BME) employee recruitment and retention, organizational culture was identied as the root of BME employee developmental and promotion problems (Oikelome 2007, 6). Oikelome (2007) found a cultural shift needed to take place before the development of both clinical and non-clinical BME sta could produce real results. Calderdale and Hudderseld NHS Foundation Trust (2006) published a case study on their merger of two hospital acute Trusts in 2001, reecting positive outcomes. Each of the former Trusts had already achieved the Investors in People (IiP) Standard and used this framework to overcome organizational cultural dierences and improve its strategies in people management and development. By 2005, it had achieved good ratings and a three star rating from the Healthcare Commission. By August 2006 they had also accomplished validation of the NHS benchmark of Improving Working Lives Practice Plus (IWL).

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Calderdale and Hudderselds (2006) case study is a descriptive narrative of their changes. However the Healthcare Commission audit website conrms that the Trust has continued to achieve high ratings, achieving excellent for the past two years (Healthcare Commission 2008a). It is now considered one of the top performing Trusts in the country, with high sta retention. IiP is seen as eective as it integrates business plans and objectives as well as facilitates cultural change in organizations. However, critics of IiP believe it can be labour intensive to prepare for authentication and concentrates more on sta and less on to whom the service is provided (Discovery 2006, 29). Nonetheless, as the Trust intentionally focused on their sta to implement communication initiatives such a factor would not be considered a negative. Any impact of additional preparatory work is unknown as there is no mention in their case study. Calderdale and Hudderseld NHS Foundation Trusts (2006) case study and audit results demonstrate their eorts were not achieved overnight. The merger took place in 2001 and yet it took a further four years to attain positive audit results in 2005 and achieve Foundation Trust status by 2006. This endorses how integration and accepting organizational change following a merger takes time, depending on how friendly or hostile the merger has been (Buono and Bowditch 2003, 194). As organizations go through shared experiences, they are brought closer together or pushed apart. Where mergers fail it is as a result of ineective management of the process, suggesting failure arises from managers waiting for the merger to embed without assisting the process along (Buono and Bowditch 2003, 194). Merger failure rates range from between 50 to 75% (Boxall and Purcell 2003, 220; Napier 1989, 271; Carleton and Lineberry 2004). Boxall and Purcell (2003, 221) identied combining cultures or management styles results in diculties in organizational t. How well the human factor of the implementation stage is managed, as part of the stabilization period post merger, remains one of the main challenges. The crucial point is that the extent employees suer from uncertainty and insecurity as the company they have come to know is essentially swallowed up by the new organization. Research design and methods Case study approach A case study approach (Bryman and Bell 2007) was chosen as the overarching methodology to elicit views and understand team dynamics. A range of data collection techniques generated a case study of how the Trust merger had impacted upon employee development by examining the: (1) Mergers impact on the newly created localities learning and development functions; (2) Extent of knowledge sharing in the merged organizations; (3) Access to personal and professional development; (4) Post merger integration of HRD provision. Data were compiled for the case study through: . A form of micro ethnography (Bryman and Bell 2007, 443) . Individual interviews

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. Group discussions . Focus groups . Triangulation through primary and secondary quantitative surveys on locality training, the 20072008 National NHS Sta Survey (Healthcare Commission 2008b) and Trust documentation. Design methods for data collection and analysis The element of micro ethnography refers to the observation of sta across a southern region in England. This method was undertaken to understand the organizational context over a shorter period of time than a full-scale ethnography approach. Given the high quality of in-depth sampling of the 20072008 NHS National Sta Survey, recent data existed on sta opinions of training and engagement for secondary analysis (Bryman and Bell 2007, 328) and comparison with the perspectives in the merged Trust. The data in the case were gathered from employees involved in the commissioning or provision of training. Of the 61 employees approached, 49 agreed to contribute, representing a response rate of 80%. Twentyone unstructured interviews were undertaken with a range of respondents. Purposive sampling was used to select and invite professionals with a good knowledge of and involvement in employee development. Morse (2010, 231) describes an excellent participant as one who has been through or has observed the experience under investigation. The following is a list of participants by job role: . . . . . . . . . . Learning and Development Manager Former Trust A Head of Learning and Development HR (Locality) Managers/Directors Associate/Assistant Medical, Nursing, Occupational Therapy Directors Chief Pharmacist Joint Training and Development Ocer BME (Black and Minority Ethnic) Lead LGBT (Lesbian, Gay, Bisexual and Transgender) Chair Exemplar Employer Lead HR Review Project Managers

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Nine group discussions were conducted with groups no larger than ve involving: . . . . . . . . . Trade Union Representatives Psychological Therapies and Medical Directors National Vocational Qualication (NVQ) Team HR Review Project Managers Workforce Development Co-Ordinators HR and Assistant HR Director HR Co-Ordinators Health and Safety Trainers BME Group

Participants in the interviews and group discussions were asked to comment on their area of workforce development with occasional prompts for clarication. This unstructured approach was used in order that participants could oer personal

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insights by exploring their own beliefs and perceptions. However, as the interviews were focused on learning and development, a degree of structure was involved (Saunders, Lewis, and Thornhill 2007, 312). Two focus groups were conducted at two Trust-wide HR away days to gather more detailed qualitative data. Each participant was given a felt pen to write his or her responses on a paper tablecloth. The tablecloth was used to authenticate and check the notes taken at the events. The rst HR away day was held in January 2008 and the second in April 2008 with groups of eight comprising of: . Group 1: workforce development team . Group 2: HR heads of departments The aim of the focus groups was to discover multiple viewpoints, attitudes and motivations, shared beliefs and perceptions on employee development since the merger by asking a short series of questions: . What learning and development activities were provided in your former Trusts strengths and weaknesses; . What are the current learning and development activities provided in the new Trust and how do these compare with the former arrangements; . How have these impacted on service provision strengths and weaknesses; . How can we engage with employees through learning and development activities; . How best can workforce development support the business objectives and employees in the Trust. The responses were shaped by interactions within the groups, which had their own importance. They were not excluded simply on the grounds of possible groupthink, as collective insights were of interest in addition to individual opinion en masse (Smithson 2000, 115). These dynamics enabled more perceptions and ideas to be explored in depth. A survey questionnaire was distributed to the three executive locality directors to investigate the provision of training courses and funding arrangements in the Trust to triangulate ndings on perceptions of a lack of training. However localities do not maintain central records, so the data provided was not exhaustive. Hence each locality director emailed the questionnaire onto their heads of department to complete. In some instances these were followed up with either a telephone or interview to clarify the information sent, where there was a lack of sucient detail. Secondary source data were obtained through accessing previous research, internal Trust documentation and the National NHS sta survey (annual survey assessed against the national average of similar NHS Trusts) for 20072008. The sta survey randomly sampled 837 of a total of 3738 eligible permanent sta. A total of 504 sta responded, representing a 60% response rate on sta attitudes to employment and training. Nursing professionals represented the largest group response of 206 (43%); 180 responses (30%) from non-clinical sta, (corporate, administration, ancillary sta, social work) and 84 responses (18%) from allied professionals (clinical therapies). Medical professionals represented the smallest

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percentage response rate of 32 respondents (7%) with a small percentage discounted due to incomplete responses. These documents were used to provide insights into professional and other sta expectations and were compared with current practice through triangulation with data from the interviews, group discussions, focus groups and observations. A descriptive narrative analysis has been used to build up a comprehensive picture of the current workforce development situation based on participants viewpoints and perceptions, combined with personal observations. Participants quotes have been interwoven to reect the emotional impact and to place emphasis on the points made. To avoid losing the original meaning of the participants contributions, extraneous material has only been edited where, for example, contributions have become repetitious, meaningless or are not relevant to the research question (Gilham 2008). Emerging themes (regular and repeated comments and observations) reect the link to the literature review with similarities and dierences identied. The narrative is written within the investigative headings listed at the start of the methodology section, to ensure the focus of the research remains relevant and pertinent. Ethical considerations To gain informed consent, the research purpose was clearly outlined at the onset when making arrangements with the participants. Assurances were given that any information, which might directly harm individuals, would be removed and specic comments would be anonymous to allow for greater freedom of expression (Saunders, Lewis, and Thornhill 2007, 187; Bryman and Bell 2007, 133). In this way, employees who were reluctant to provide opinions could absent themselves if they wished. Overall, from the response rate of 80%, participants welcomed the study and the 20% who declined did so mostly due to scheduling or availability problems. Contemporaneous notes were taken rather than using electronic recording equipment, to avoid limiting comments and encourage free owing contributions. The paper tablecloth notes provided a reminder and checklist of participant responses for cross referencing after the meetings. Findings and analysis This section gives a brief background to the context in which the merger took place. Then the paper outlines the ndings and analysis of the impact on workforce development and how the former organizations culture has been integrated, post merger. Background to merger The Trust has experienced signicant change since its formation in 2006. As the commissioned provider of mental health services across a region in the south of England, the Trust was formed from two whole Trusts: Trust A County Healthcare, Trust B Health and Social Care and the mental health services of a Primary Care Trust (PCT). Following the merger they have become Trust A Locality, Trust B Locality and Trust C Locality with their corporate headquarters situated in the south of England.

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One of the Trusts strategic objectives is to become a Foundation and Teaching Trust in 2008. Although still part of the NHS family, Foundation Trusts are free from central government control with exibility over their nancial and investment decisions and in tailoring their services to local community needs. However, aspirant Foundation Trusts must meet specic standards of performance and provide assurances on how they manage leadership and workforce development (Monitor 2008). With the exception of medical practitioners, areas of the Trust have reected a reluctance to adopt a more integrated approach with their new colleagues and work together on learning and development initiatives. Two years after the merger, policies remain out of date; training budgets remain divided and one sta group controls one personal development budget. Additionally, the learning and development department is partially centralized whilst other areas of learning and development remain within their former Trusts e.g. National Vocational Training (Trust A Locality) and Social Care Training (Trust B Locality). Externally, there is the economic challenge in maintaining stang requirements whilst cost eectively meeting legal competency standards. The 2009 European Working Time Directive (WTD) is both an opportunity and a threat to internal operations. The maximum working hours of junior medical sta will reduce to 48 hours per week forcing NHS Trusts to look at new ways of working and role development of other professional sta. However, weaknesses in the training provision and allocation of funding may mean these healthcare professionals will receive insucient support. Mergers impact on the localities learning and development functions Four years after the merger, the Trust still has no training strategy, policy, training plan or central training records to co-ordinate processes. After the merger, redundancies were unevenly spread across the Trust with stang and the corporate headquarters predominantly being made up of sta from Trust Bs former Trust. Additionally, Trust Bs learning and organizational development section became the new Trusts learning and development department, following the closure of Trust As Localitys workforce development department (except for its NVQ function). As a result, many Trust A Locality sta have experienced feelings of a takeover and unfairness as the restructure seemed based on location rather than integrating locality eciencies impartially. Trust A Locality Before the merger, Trust A Locality held the IiP award and IWL status (awards made after independent audit of sta experience of learning and development activities within an organization). It was also one of the former NHS Universitys pilot sites. The workforce development departments team of 13 in-house trainers delivered clinical, management, NVQ and soft skills training. Training and personal development plans were recorded and monitored centrally, used to formulate the annual training strategy and plan. Training accommodation was extensive with fully equipped classrooms to practise nursing and management skills. The former Trust also provided training to external NHS and non-NHS organizations, generating income that covered its own and much of HRs overheads. As such, Trust A HR

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sta feel: We had a really excellent reputation for high quality training with other Trusts . . . we just dont understand why . . . [Trust A] . . . showed no interest in having a department that could pay for itself . . .. Trust B Locality Prior to the merger, Trust B Locality also held the IiP award and IWL status. The Learning and Organizational Development section had seven sta and was part of HR. Training was delivered by in-house trainers or commissioned from external providers. The Healthcare Commissions 2005 Audit highlighted problems with its training provision and lack of central training records. After the merger, HR moved to another location in the south of England. Many of the trainers were redeployed to other directorates, leaving behind one management trainer and two administrators in a mostly empty building as the new Trusts learning and development team. Since the merger, one employee has been o sick with stress for a number of months and the remaining two reported feeling forgotten and unsupported. Trust C Locality Trust C Localitys former Trust was awarded IWL. However, in its 2004 Audit, the Commission for Health Improvement (the Healthcare Commissions former name) was critical of their training arrangements, especially regarding their sta performance. Trust C has strong ties and appreciation of Trust B Locality, [they] took us under their wing, after the transfer. Interestingly it was Trust B Localitys clinical management team, rather than the learning and development department, who helped organize their KSF and performance development. Power dierentials in knowledge sharing Findings show power dierentials between clinical and non-clinical sta and between localities. As commented by a senior member of the medical team and BME member:
. . . there is an apparent gap between clinical and non clinical sta generally and I feel strongly there is a need to close this gap so that doctors can learn from the rich sources of ideas held by other sta groups.

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Localities act separately reecting power dierentials and cost ineciencies intensied by an uncoordinated approach in the learning and development departments working practices. At the bi-monthly learning and development forum, the HR director spoke of a new Trust-wide leadership and management programme for Band 7s upwards. Surprise and frustration were evident, when Trust B and Trust C Locality representatives (nursing managers) advised they had also commissioned separate management training. However, there is comprehensive knowledge sharing between senior and junior medical grades. Clinical and cross-team best practice development is widespread.
. . . the groups [clinical forums] have been set up to share practice and develop ideas across services, localities and professions and we benet from developing clinical practice and improving service-user experiences.

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Findings show an inecient sharing of knowledge across organizational barriers since the merger, creating inconsistent management support, poor economies of scale and duplication of training. To verify perceptions, a follow-up survey was undertaken, and collated with the training advertised on the Intranet (listing dates and eligibility criteria). From the follow up study it was evident that: . Trust C Locality sta are only oered training at Trust B Locality despite being situated within equal travelling distance of Locality A and Locality B. . Health and social care training is only advertised as eligible to Trust C and Trust B Locality sta. . Minimal management competency training is only oered to Trust B. . Extensive nursing and allied health training is provided in Trust A Locality but not oered to either of the other localities. . A 60,000 bonus awarded for meeting local targets is nancing Trust B Locality leadership training for their management team, and ring fencing the funding is justied as: Its our money so we should spend it on our own people. . Trust Cs management training is not extended to others within their locality, We have fteen integrated team managers (ITMs) receiving intensive management training, nanced by Care Services Improvement Partnership (CSIP), whereas weve got other managers not receiving any development training. . Only compulsory training is open to all localities. As co-ordination of most training courses are organized by nursing, non-clinical sta and the learning and development department, it suggests the separation between localities originates from these groups and their reluctance to exchange knowledge with other localities. Access to personal and professional development Medical professionals have their own appraisal system, which is reported as open and eective. Although allied health professionals use the KSF appraisal system, they are guided by set structures within their own professional bodies and so also report positive outcomes. Medical and allied health professionals benet from strong development support:
Were fortunate. The new Medical Director has put in structures and programmes for developmental training via the Deanery or separately commissioned development programmes, under MPET [Multi-professional Education and Training] funds.

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In Psychological Therapies, locality leads and directors report working closely together to commission professional development, and Occupational Therapy has a structured development programme led by a proactive assistant director. In contrast, there is variable interpretation and application of the KSF and performance development review process within nursing and other sta groups to guide sta development. Managers reported carrying out regular supervision and annual appraisals but with variable approaches, arising from a lack of a Trust-wide policy or management understanding. In the words of an assistant HR director:

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Interestingly, whilst front line managers were conducting appraisals with their teams they did not necessarily receive any regular supervision [reviews] or appraisal [reviews] from their line manager. There were team members who did receive supervision and appraisals [reviews] but did not understand the dierence between the two and thus referred only to receiving supervision and not an annual appraisal.

The sta survey reported only 27% of sta felt they had received well structured appraisals. Although 62% of sta reported receiving an appraisal, performance development review, KSF development review or other such review in the last 12 months, only 51% of sta said they had agreed a personal development plan as part of their appraisal or performance development review. This would suggest training needs are not consistently discussed or addressed as part of the review process. Signicantly, as the two largest survey respondents were nursing and non-clinical sta, it endorses that the problem is largely within these groups. The majority of Personal Training Days (PTD) monies are allocated to qualied nurses to study for masters and postgraduate qualications. However, without central training records or consistency in appraisal development outcomes, the choice of study may be inappropriate and inconsistent. The Nursing Directorate manages the PTD panel applications. As such there is a general perception funding is only available to qualied nurses. A senior member of the nursing team highlighted concerns on the: inequitable access to study and the application process is unclear and poorly advertised, with only approximately six Band 8a non-clinical managers receiving PTD funding for their study. There is limited choice and investment in development for sta below Band 7, particularly for those with existing qualications. Bands 5 and below can work towards a limited range of NVQ qualications. However the reduction in substantive vocational training sta has left areas of development work neglected, preventing the assessment of future training and succession-planning needs, particularly in the light of an aging workforce. Despite funding provided by a local college and the Strategic Health Authority, under Train to Gain and Widening Participation initiatives the NVQ managers post is the only paid position. The other members of the NVQ team are unpaid volunteers from Trust A Locality stang. I call them my unsung heroes . . . they give their time freely . . . its all goodwill . . . its all voluntary and they dont even get expenses. The LGBT Group reported a Trust-wide need for all employees to receive cultural and sensitivity training to engender more open acceptance rather than experiencing specic career progression problems. Many nursing and non-clinical sta within the BME network, expressed concerns over the lack of support in career progression:
People are frightened to ask for time [o] from their managers to attend BME meetings to get people to look at training, learning and development or support it. . . . Some people have been asking for training mentorship for years. Theyve lled in the forms and thats been the end of it, repeatedly. . . . Theyve waited and waited but got nothing back. . . . Whilst this has been happening, new people [white] have gone on above and got onto mentor programmes.

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Also, concerns were expressed on, ever breaking through the glass ceiling (the unseen barrier to career progression). Interestingly, one director stated, the Trust doesnt have a glass ceiling . . . we have BME people in senior positions, from Band

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7 up to Board Level, based on a perception the glass ceiling is broken once BME employees break through. However, there were only two (non-clinical) BME members of sta, one at Band 8a and the other at Band 9. From the BME Network perspective, the glass ceiling is only broken once there is an even distribution of BME sta at all senior levels. Monitoring records reect the majority of BMEs are at Band 5, with the next largest group in the medical profession. As ndings show minimal opportunities for all sta banded below Band 7, regardless of ethnic background, there is insucient data to assess where BME sta are more disadvantaged without carrying out further research. Post merger integration of the human factor Without the time and management support, localities have not acclimatized and stabilized to the merger changes, impacting on employees psychological contract and causing a feeling of disempowerment and a withdrawal of trust and support. Findings show existing policies have not been integrated or adopted. Both Trust A and Trust B Locality still use their own policies, posted on the Intranet with Trust C Locality still referring to their previous Trusts Intranet policies. Without a common policy, the Trust has had diculty establishing a common culture and mutual understanding, as illustrated by its variable approach to supervision and appraisals. This reects the failure of the merger to integrate learning and development as it mirrors the ndings of a consultancy project review undertaken 18 months after the merger to support their application for Foundation Trust status. Foundation Trusts are independent, not for prot public benet corporations with accountability to their local communities rather than central government. The review examined the current provision of its HR and Learning and Development service and provided proposals on optimising service delivery and combining the HR and Learning and Development Departments into a single new HR Delivery Model. The external consultants reported employees feeling disconnected and unsupported by senior managers and directors, problems with managers performance management skills and stress management. Further, there was reported employee speculation on what the plans for becoming a new Foundation Trust would mean to their jobs causing additional concerns. This is supported by sta perceptions in the sta survey. In the sta survey, 22% of sta agreed with at least four of the following six statements that they know who senior managers are; that senior managers communicate eectively with sta; that they try to involve sta in important decisions; that they encourage sta to suggest new ideas for improving services; that they act on sta feedback and that healthcare professionals and managers in nonclinical roles work well together. This percentage fell below (worse than) the national average of 28% in similar Trusts. The Trust also fell below (worse than) the national average on the extent they felt that their immediate manager provided them with support, guidance and feedback on their work and their opinions before making decisions that aected their work. The lack of communicative support from senior management reects further power dierentials, increasing tensions and acts as a barrier to sta. Where areas of eective management support have been reported, this appears dependent upon

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individual managers skills, experience and attitudes as opposed to a Trust-wide consistent competence. The sta survey showed an increase from 33% to 38% in sta suering from work-related stress over the previous 12 months. This rise reects working in the Trust is not improving and appears to be worsening particularly as the national average in similar Trusts is 20%. Without open support and communication from managers to assist with the merger and integration process, nursing and other sta groups do not appear to have had positive shared experiences to bring them closer together. In Trust A Locality, employees seemingly huddle together to lick their wounds, as if to gain strength in numbers.
Weve gone through so much change and there are still people leaving because of redundancies. We call ourselves the survivors . . . over the last 12 months we have regrouped into . . . (main Trust A Locality site), so weve become very close.

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Trust B Locality expressed low morale and minimal support and appears fearful of more changes by expressing a need to be, just getting on with our jobs and keeping our heads down. In contrast, employees at Trust C Locality appear more open and relaxed. They have continued to work alongside their former colleagues from their former Trust (prior to the merger), as their sites are situated closely together. With less outward changes to their working environment, there appears minimal impact on Trust C Localitys organizational culture. However, this may be indicative of achieving a sense of security by remaining within their comfort zone, rather than having adapted to the changes quicker than the other two localities. Discussion and conclusions This section re-examines the original research intentions with a brief summary of the key issues and a discussion of the implications. Also included, are recommendations for future research and limitations of the study. Research purpose The core competencies of the Trusts professional, nursing and non-clinical workforce are critical to its service provision and the need to develop new ways of working to meet current legislation and service needs. However, two years after its merger the Trusts sta are still adapting to the cultures of two former Trusts and a mental health service. As such there are inconsistencies between localities, which have impacted on their education, training, and development provision. Key issues There are power dierentials and culture clashes across the Trust, which have created barriers, stress and isolated approaches to the provision of training. Senior managers and directors have added to the power dierentials increasing tensions, as they are seen as remote and uncommunicative. However, professional groups have a

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strong management structure with facilitated clinical and cross-team best practice development across all localities. The Learning and Development Department has failed to co-ordinate training or put in place processes and strategies. Nursing and other sta groups do not have a consistent appraisal policy causing variable outcomes, adversely aected by the variable performance management competencies. Qualied nurses have greater access to funded study compared with other sta groups, particularly sta in lower grades, who have limited personal and vocational development. In contrast, professional sta have clear and consistent development structures with designated funding to maintain their personal and professional development. Implications In response to the research question, this study highlights the impact the merger has had on the delivery of learning and development within the recongured organization. The results suggest that the anticipated benets of pooling resources and economies of scale in learning and development have not been realised; for example integration and equitableness of workforce development provision. The two key areas to emerge from the ndings that impact on learning and development provision in the new organization are cultural clashes and power dierentials between localities and between professional, nursing and non-clinical groups. As argued by Boxall and Purcell (2003), the separation between the localities illustrates the organizational injustice over the new Trusts restructure, leading to feelings of long-standing resentment due to the perceived unfairness of decisions. Cortvriend (2004) demonstrated how the Trusts redundancies could negatively aect employees psychological contract, with the lack of time to acclimatize to changes, having a profound eect on relationships (Buono and Bowditch 2003). As a result employees feel separation anxiety and uncertainty causing higher stress levels over the past year (Cortvriend 2004). Gaps and power struggles in knowledge sharing across boundaries have increased because managers failed to oversee the integration processes and harmonize the cultural dierences (Boxall and Purcell 2003). The overall perception is of poor communication by senior management, inconsistent management competencies and inadequate coordination of Trust training that highlight unequal allocations (Fulop et al. 2002), failure to exploit economies of scale and opportunities to share good practice across the new organization. In contrast, the strong management structures for the professional groups have supported and encouraged exchange of knowledge and the development review process. Findings show how the teams have gained from sharing clinical and crossteam best practice, creating strong team relationships and beneting from positive leadership styles as Currie and Suhomlinovas (2006) research recommends. Management rely on their professional bodies guidelines so development reviews and training are supportive and consistent. As professional teams have had time to embed processes, overseen by open communicative management, it has created trust and respect through shared positive experiences (Buono and Bowditch 2003). However, ndings demonstrate nursing and other sta groups have variable approaches, without clear policy guidance to provide structure, creating inconsistent development plans and opportunities. As identied by McBride and Mustchin (2007) the NHS traditionally invests more in clinically registered sta than in

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non-professional sta groups creating disparity between the vast development opportunities for medical and registered sta groups compared to non-clinical sta, (particularly those below Band 7), reecting the inequitable opportunities. The NHS Plan 2000 outlined the need to improve career opportunities for sta without qualications (NVQs), but the Trust has not followed through on this guidance. Additionally, for non-clinical sta with qualications, personal development appears limited with poor processes in place to access funding. Financial constraints are usually cited as the problem yet with an aging workforce the lack of investment in sta could be viewed as short-sighted, with the need to develop and plan for future workforce needs overlooked. Findings are inconclusive on the glass ceiling barrier for BME sta and the specic disadvantages for Band 5 BMEs compared with other Band 5 sta, as both experience poor development. Oikelome (2007) posited the need for a cultural shift before organizations can understand the benets of improving career opportunities for BME sta. Therefore, further research is necessary to clarify this area. Limitations According to Macmillan and Tampoe (2000, 34) each context should be studied in isolation because of its unique characteristics. One must therefore take care not to over generalize the results of this research for all NHS Trusts or other organizations facing similar issues; the paper provides an indication of the likely outcomes of a merger on learning and development in an organization where there is a lack of attention to coordinated action to realise the potential benets. On the other hand, as Korte (2010, 38) points out the use of a case study could also be seen as being advantageous for the purpose of this research (which was to explore a phenomenon in depth) because the focus on one organization helped to reduce extraneous factors in the environment that could confound the data. Another limitation is that because contemporaneous notes were taken with regards to the interviews and focus groups, the researchers may have not captured the true meaning (such as the intonations, which give dierent meaning to words) of what was being said. However, by not audio recording the interviews and focus groups the focus was on the interview and not on the audio recorder which may have inhibited respondents responses (Saunders, Lewis, and Thornhill 2007, 334). Conclusions This study makes an important contribution to the research on the impact of a merger on the learning and development of the workforce. In doing this it also provides a contribution to practitioners and researchers who wish to learn from an organizations experience of merger. In compiling this case study it has become clear that there is a dearth of studies on the experience of post-merger impacts on workforce development and future researchers might wish to consider conducting the following: . A cross-sectional qualitative study of other NHS mergers, to build a body of knowledge that can inform practice. . A cross-sectional study of development opportunities for all sta groups across NHS Trusts with particular focus on whether there are dierences in provision for sta outside the professional and higher grades.

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. A study of the potential of a revised bid for the IiP award by the merged organizations, in embedding integrated learning and development relationships, processes and work practices to overcome cultural dierences and improve communications.

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