On paper the merger was obvious: adjacent regions, complementary specialisms, a combined balance sheet that could fund what neither side could build alone. The board hesitated anyway, and could not fully articulate why. We were asked to find the substance behind the hesitation.

Taking the doubt seriously

Most advisers are hired to get a deal done. Our brief was different — to test whether the instinct to decline was wisdom or fear. We rebuilt the integration assumptions from the bottom up and found the board was right to hesitate: the clinical governance model was the real risk, not the finances.

The deal, on different terms

The merger completed nine weeks later than planned, with a revised governance structure both boards accepted, at a combined value of £340m. The delay was not a cost. It was the price of a merger that held.