Bedford Daycare Hospice was a small hospice that provided outpatient care three days per week. It had struggled to expand its services; it did not employ any doctors and had been unable to gain CQC registration. It did not have the capacity to implement the SystmOne records system to facilitate wider system working. The hospice was at risk of not being able to fulfil its vision or charitable aims.
The two hospices discussed options for Keech Hospice Care to support Bedford Daycare, and decided that the best solution was for them to merge.
The merger process began in January 2023, and the hospices officially became one organisation on 1st June.
Rather than creating a new organisation, it was agreed to maintain the Keech brand and cease the existence of Bedford Daycare Hospice as a charitable entity. The Bedford Daycare building has retained “Bedford” in its title.
Outcomes
The merger has enabled Keech Hospice Care to offer palliative and end of life care for adults all over Bedfordshire.
Rather than losing services, the daycare service in Bedford has been extended. Keech is now providing extra days of support. Patients can now access complementary therapy, financial advice and see a doctor at the hospice. Many more services are planned.
No jobs have been lost in the merger. The Bedford Daycare teams have merged into the different parts of Keech, with harmonised terms and conditions. Staff are also able to access benefits such as the employee assistance programme, which the larger organisation can provide.
Facilitators, challenges and advice
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Key facilitators
Keech and Bedford Daycare set up a steering group to oversee the merger, which included trustees of each hospice. They met every two weeks to monitor progress. They employed Eastside people, a charity consultancy, to lead the merger process, and VWV for legal advice.
Keech’s leadership team developed a transition plan, which helped them work through all the necessary tasks. This used the same headings as their COVID-19 survival plan, which helped them prioritise patient safety.
The hospices decided to tell staff about the merger early in the process. The leadership team did not want staff to hear the news from another source, as they felt this might fuel anxiety. Instead, they focused on the idea of the two hospices going on a journey together, to find a solution that benefits everyone.
Although the hospice has maintained the Keech branding, there was a strong feeling that they did not want to lose the strengths of Bedford Daycare. The Communications team has been tasked with writing the history of the hospice, recording interviews with Bedford’s founder. Information about Bedford Daycare has been incorporated into the staff induction process.
Challenges
Any merger process is costly, particularly because it proved complicated for the legal team to get hold of documents such as lease agreements and health and safety records for Bedford Daycare’s shops. This was partly because it involved tracking down landlords. In some cases, the hospice decided to carry out health and safety checks again rather than waste time tracking down the documentation.
The due diligence process took time and the hospices formed a confidentiality agreement until the merger was official. They did not want to cause anxiety or raise hopes if the merger should not go ahead.
Both hospices had staff vacancies (including the General Manager at Bedford Daycare) and there were some big recruitment challenges while the merger was in process. It was very difficult to make a clear employment offer to new staff when the hospices were not sure of the future. At Bedford Daycare, one of the trustees stepped down and took over as manager until the merger was complete, with the agreement of the Charity Commission.
Tips and advice
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Don't shy away from considering a merger.
A service may be small, but that doesn't mean it is not important. Larger organisations should consider whether they can support smaller organisations with a similar ethos, to help beneficiaries in the long term.
For a merger to be successful, your board of trustees needs an appetite for risk. If a smaller organisation is merging into a larger organisation, the larger organisation will gain assets but also liabilities.
Due diligence is never perfect. There will always be things that come to light after the merger is complete (these might be things that the other organisation didn’t know about!). So you need to take a balanced view of risk.
It’s important to get your trustees on board and keep them updated on the process. Keech held a separate meeting with the Board and the legal team, so that trustees could ask questions. They completed a business case, clinical plan and risk plan and project plan so that the trustees had all the information they needed before voting on the merger.
You can’t control everything, particularly legal processes! You need to factor this into the time scale.
Be prepared for the organisation you are merging with to have a different level of governance to you. If you are merging with a smaller organisation, they might not have had the capacity to develop expertise in this area.
Future development
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Although the merger is legally complete, there is still lots of work to do to integrate staff and processes. Every area needs to be considered, from stock ordering processes to the organisations’ websites.
There are lots of opportunities for development, for example giving staff the opportunity to work at different sites, and exploring new income generation opportunities. Bedford Daycare had five residential flats which it let out, which means that Keech has become a landlord.
The hospice plans to map competencies for the merged workforce and develop a new Competency framework with associated training.
Keech has invited some of Bedford Daycare’s trustees to join its Board, as they will bring new expertise and historical knowledge. Two applicants will be interviewed as part of a skills based recruitment process. This will be an important part of moving forward as one hospice.
