Two foundation trusts have referred NHS England to Monitor over the way specialised cancer surgery services are commissioned.

Monitor announced yesterday it would investigate complaints from University Hospital of South Manchester Foundation Trust and Stockport Foundation Trust about the process overseen by NHS England’s Manchester local area team.

The trusts allege the process breached procurement and competition rules.

The move is the latest twist in a long-running conflict over where surgery for upper gastro-intestinal cancer and urological cancer is provided in the city.

HSJ understands the two trusts are complaining about a reconfiguration process that led to a recommendation several months ago that Stockport lost urology and South Manchester its upper gastro-intestinal work.

The urology work would instead be concentrated at Salford Royal Foundation Trust and the Christie Foundation Trust, while the upper GI work would go to Salford and Central Manchester Foundation Trust.

It is understood that two years ago commissioners agreed a plan to concentrate upper GI cancer surgery at Salford and South Manchester but Central Manchester then threatened a judicial review.

Central Manchester was asked to confirm this but HSJ received no reply before this article was published.

HSJ understands Central Manchester was persuaded to abandon legal action because of the controversy surrounding the expensive judicial review proceedings that were then being started by the Royal Brompton and Harefield Foundation Trust in London over the national configuration paediatric cardiac surgery services. The Brompton judicial review was the first time a foundation trust had taken another NHS body to court over the configuration of services.

The reconfiguration process was subsequently restarted under the Greater Manchester Cancer Services Provider Board and this time the outcome was less favourable to South Manchester.

The board was convened by NHS England’s local area team and comprises the chief executives of 11 cancer service provider trusts. It is examining where services should be provided for 14 different cancers to meet national guidance.

Former NHS Midlands and East chief executive Sir Neil McKay was appointed to chair the board in late July and the South Manchester and Stockport complaint was made to Monitor prior to this.

In a statement Monitor said the complainant trusts had alleged that “the process adopted to select future providers of certain cancer surgery services is not based on the quality of services, patient outcomes or patient preferences.”

One source told HSJ there were too many upper GI cancer surgeons working in Greater Manchester for them all to perform the recommended minimum of 15 procedures a year.

The local area team confirmed that last year there were less than 150 upper GI cancer surgery cases in the city.

HSJ understands there are six surgeons performing this work at Salford, three at South Manchester and four at Central Manchester.

One senior source in Manchester said: “Most impartial people think South Manchester haven’t got a leg to stand on, that they don’t do enough of these procedures. But that Salford and Central Manchester have been a bit bullying about it. The complaint is that it is a cabal.”

In June the Royal College of Surgeons published its 2013 National Oesophago-Gastric Cancer Audit. Although warning against drawing conclusions from the small numbers of patients treated, the audit appeared to show South Manchester recording the best performance in the country, and Central Manchester the worst.

Sir Neil told HSJ: “I think the Manchester provider trusts and commissioners should be applauded for trying to drive a process that will bring about solutions to long-standing concerns about cancer services in the city. Manchester has been lagging behind.

He conceded there were “wrinkles” in the process but added that if the Monitor complaint helped “iron those out then I welcome it.”

Monitor will be interviewing the parties over the next two months and plans to issue an update in October.

A spokeswoman for Salford expressed disappointment with the referal to Monitor but pledged to co-operate with the investigation.

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