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Since 1990 the National Health Service (NHS) has undergone a sustained period of change. This change has been necessary to prepare the NHS for the task of meeting a demand for services that continues to rise more rapidly than the availability of resources. Anecdotal evidence suggests that one of the most popular ways for trusts to improve their ability to meet demand is through mergers with other trusts. However, little rigorous research has been conducted to assess the extent or effectiveness of this strategy. A research project was, therefore, initiated to better understand the extent and impact of merger activity within the NHS. A questionnaire was developed and distributed to the chief executive, finance director, medical director and human resources director in all the 460 trusts that are currently members of the NHS confederation. In total the survey generated 459 responses out of a possible total of 1,840; an encouraging response rate of 25 per cent. The results of this research provide significant new evidence that “merger mania” has taken hold within the NHS. While 46 per cent of all responding trusts indicated that they had already merged, are actively involved in a merger, proposing to merge or are talking to prospective partners, a further 18.7 per cent of all trusts are forming strategic alliances rather than opting for a full merger. The dominant justification for merging are the beliefs that it will facilitate the reconfiguration of services and ultimately improve patient care. The paper concludes with a discussion of the significance of these results, before making recommendations with regard to their implications for future merger activity within the NHS.

In the summer of 1998 the National Health Service (NHS) Confederation in the UK used the opportunity provided by the celebrations marking the 50th anniversary of the NHS to engage in an exercise designed to stimulate thinking about the future of health services in Britain. A key part of this involved the creation of two possible future environments of the NHS. These became known as “the Madingley Scenarios”. In this article, the context of this work is briefly outlined before describing the main drivers that are shaping this environment (technology and information, new power structures, the changing relat ion ship with the living environment, and the effect of social and cultural change). The scenarios themselves are then outlined followed by some reflections on the value of this work in healthcare and beyond.