The co-operation and competition panel is expecting a surge in cases evaluating the costs and benefits of acute trust mergers, says its director Andrew Taylor.

In an interview with HSJ, Mr Taylor said most of the panel’s cases to date had been community services mergers, but it was seeing a number of acute trust mergers “on the horizon”.

One of the benefits that might come about from a merger is that greater scale might actually bring clinical benefits

“We are getting a number of acute trusts in the early stages of thinking about mergers with other organisations coming and talking to us,” he said.

He said so far the panel had not had to make “a really tough call” but “some of the judgement calls are going to get trickier”.

The panel has appointed a clinical reference group to help it weigh up the clinical benefits of proposals. Mr Taylor said the group would advise on cases across the board, but the panel particularly wanted to be prepared for acute trust mergers.

“One of the benefits that might come about from a merger is that greater scale might actually bring clinical benefits. [We want to] make sure that we are familiar with the arguments and that we can take that clinical evidence into account,” he said.

However, Mr Taylor added that feedback from its consultation on its draft guidelines had revealed a need to be clearer about the cost-benefit framework the panel uses - particularly weighing up the need to maintain patient choice against other benefits of merger. It also intends to make the distinction between co-operation and collusion clearer.

The draft guidelines refer to a market share threshold of 25 per cent often used in other industries as the point at which concerns about the effect of a merger on NHS competition would be raised. The reference to the benchmark has been criticised by unions.

A motion for next week’s annual TUC congress says: “Congress is alarmed by the establishment of the co-operation and competition panel, which will help companies break into the NHS. Panel guidance suggests that mergers resulting in a market share of 25 per cent will be investigated - effectively ruling out mergers between in-house PCT provider arms.”

Mr Taylor said this reference was likely to be removed, as “we do not really place much emphasis on market share”. The panel was keen to understand the unions’ concerns, he added.

Organisations requesting informal advice from the panel

PCTs – commissioners26
Acute trusts19
PCTs – provider arms9
Law firms advising NHS organisations9
Industry associations 6
Independent providers4
Third sector organisations3
Specialised commissioning 
DH and Monitor3
GPs, consultants, community pharmacies3
Mental health trusts2