NHS Trust was launched on July 5, 1948, by Aneurin Bevan, was founded out of a strong stand to provide healthcare services to all people regardless of wealth. Presently, it is recognized by the World Health Organization as one of the best health services in the world. The 21st century has brought demands which triggered the NHS Trust to have improvements in order to cope and keep pace with the changing time. They are now changing the way they work with the patients, making sure they come first above all. In line with this undertaking is facing the fundamental changes in the structure of NHS Trust and in the way the various organizations relate internally with NHS Trust and come July 2000 was the launching of a full-scale modernization program in which new principles were added (The NHS Plan, 2000).
In recent years, many mergers and reconfigurations have taken place in NHS Trust. From 1997, 99 trusts mergers took place. 14 of which are in London (Department of Health, 2001). The mergers include horizontal mergers of mental health trusts, community health services trust and acute hospitals. Alongside this the merging of primary care groups in order to create primary care trusts. The reconfigurations are often politically debatable, which even focused on one constituency in the 2001 general election. This has led to the formation of the panel of independent reconfiguration, which intends to arbitrate the proposals on mergers and reconfiguration in order to take out the politics in the organization’s decisions (The NHS Plan 2000).
Behind trust, mergers are a wide range of driving forces. One is the target to achieve economic gains, by making the most of economies scale and scope, especially in terms of management costs. And second is the reduction in excess capacity to treat patients as a result of rationalizing the provision of services (Ferguson, 1997). Some other factors include the belief of the people that clinical quality improves as usage of specialized units increases, the medical training quality increases and the recruitment and retention of staff will become more effective (Ferguson, Sheldon &. Posnett 1997).