Two hospitals in luton and Bedford came together into one Trust in 2020. There had been over 10 years of discussions and speculation about the Bedford hospital site/Trust, which had the challenges of a small district general hospital and working effectively 7 days a week in all specialisms. The two hospitals had a long history of collaboration and the coming together provided economies of scale and was birthed from a politically charged debate about essentials on the Bedford site. The merger was underpinned by a commitment to maintain maternity, AandE and children's acute unit on the Bedford site.

The local context is that local communities are wrapped around three large towns and small conurbations and the two hospitals serve these.

David describes how they have developed cross site leadership roles for general managers and clinical directors - this has enabled benefits for each hospital site. The approach was influenced by the approach used at Barnet and Chase Farm hospital sites. Goal is for single teams across sites, no divisions - a flat leadership structure - reporting directly into executives.

The merger was transacting as an acquisition, but they have culturally developed the approach as a merger. Trust has taken time to develop -but with joint roles; merged colours/new lanyards/executive teams on site in person across both hospitals throughout the week.

The merger transaction concluded just as the pandemic took hold, which in some ways made things easier as many of the established rules and ways of working changed.

Looking forward the larger Trust will ensure there is a larger pool of talent to draw from; developing clinical leadership is easier to support and staff can be at the very heart of all the developments across the organisation.

Matthew Winn, podcast host and an experienced leader in healthcare in the UK.