HSJ’s round-up of Thursday’s must read stories and debate

‘If at first you don’t succeed, try, try, try again’

Two trusts on the south coast seem to have taken the sentiment above to heart.

Three years after the attempted merger of Royal Bournemouth and Christchurch Hospitals Foundation Trust and Poole Hospital FT was blocked on competition grounds, the two trusts are having another go.

What has caused the trusts to dust off their merger plans?

The answer seems to be acute service reconfiguration. Dorset CCG wants to move emergency and planned activity on to different sites in the east of the county (to Bournemouth and Poole respectively).

The trusts argue that this reconfiguration (which still needs to be consulted on) will be “more easily achieved under one management structure”.

However, the decision also appears to have also been catalysed by the STP process.

In a joint statement, the trusts’ chief executives said they had decided to restart their talks following an STP meeting with NHS England and NHS Improvement.

Perhaps the providers felt emboldened to reboot the merger after getting the nod from the two national bodies? It wouldn’t be the first time those organisations have bent the rules from the Lansley era.

The major fly in the ointment in all of this is the Competition and Markets Authority. Less than three years ago, Bournemouth and Poole both signed undertakings not to attempt a merger for 10 years, and they can only wriggle out from that commitment with the “prior written consent” of the CMA.

If the trusts think that backing from the arm’s length bodies will make the CMA look the other way, they may have another thing coming.

The CMA is a big, well established watchdog, which takes its statutory responsibilities very seriously. It will only waive through the merger if it is suitably convinced that the resulting patient benefits will outweigh the loss of competition that would follow such a transaction.

But ironically, it might have been the CMA which gave Bournemouth and Poole the push to start talking again about the merger.

The east Dorset reconfiguration would have led to a run-in with the CMA in any case, because concentrating all planned work at Poole would have raised competition considerations.

The parties might have reasoned that if they were going to have to square their proposals with the CMA anyway, they might as well go the whole hog and formally merge, if that would increase the chances of success.

And if that wasn’t enough merger news for  one day, it was also announced on Thursday that the acquisition of Sherwood Forest FT by Nottingham University Hospitals Trust has been delayed until 2017.

The NHS’s ‘Greece scenario’

Keeping track of NHS provider finances is a tricky business but, as ever, HSJ has endeavoured to unpack the numbers.

A document published alongside the Department of Health accounts shows that more than half of acute trusts received some form of cash bailout in 2015-16, with total “revenue support” reaching almost £2bn.

These payments, up from about £1.2bn the previous year, were necessary to maintain the day to day running of hospitals, in many cases to prevent them running out of cash to pay staff or creditors.

Although the size of the number was not all that shocking, given the huge deficits that built up among providers last year, it’s striking that the DH actually expects much of this money to be paid back.

There seems little prospect of this for many trusts, without simply requiring a further loan to pay off the old one

One HSJ reader commented: “It’s a Greece scenario. Yet to admit otherwise endangers the whole edifice, so the system goes along with this ‘kicking the can down the road’ hoping something turns up. It won’t within the NHS, although we can tinker a bit at the edges. The solutions are ‘political’ and do not look like happening anytime soon.”