The NHS Co-operation and Competition Panel has approved the merger of two Kent acute trusts despite concluding it offered “no benefits” to offset its costs to patients and taxpayers.
The competition watchdog’s review of the proposed merger of Dartford and Gravesham Trust and Medway Foundation Trust concluded that it would “remove the key competitive constraint” on the latter trust’s elective urology and endocrinology services.
The loss of choice and competition for these services was “likely to give rise to material costs to patients and taxpayers”, the review found.
To secure the watchdog’s approval for the merger, the trusts and their commissioners have agreed a series of “behavioural safeguards” intended to protect choice, competition, and service quality, the CCP’s report states.
Elective urology and endocrinology services at the Medway Maritime Hospital must be monitored against a set of agreed quality indicators following the merger. If performance falls to a certain level below an agreed baseline the merged trust must “undertake an investigation and rectify the issue”.
If service quality falls below the agreed range for six months commissioners must consider whether to terminate the merged trust’s contract for the services that have deteriorated, the report adds.
The commissioners must also “promote patient choice” through the publication of information to all north Kent GP practices, including lists of all providers of elective endocrinology and urology services in Kent and London, and regular updates on the performance of the Medway services.
The competition watchdog determined that these safeguards were necessary after concluding that there were “no benefits to offset the costs to patients and taxpayers arising from the merger”.
It declined to take into account the benefits that had been claimed by the two trusts, saying that these “either did not constitute benefits to patients or taxpayers, or were not specific to the merger under review”.
Among the benefits claimed, the trusts had told the CCP that they would increase profitability per square metre of their combined estate by “disposing of 15,000 square metres of estate at Medway Maritime Hospital”. Means of achieving this included “centralising education facilities as well as rationalising clinical services and back office functions”.
The CCP report states the merger parties had committed to maintaining emergency, women’s and children’s surgery on both sites, meaning “any rationalisation would be limited to inpatient elective care”.
However, the watchdog said the trusts had not provided insufficient evidence that benefits of centralisation “would be achieved in a timely way”.
It added: “We were unable to lace weight on unspecified plans that rely on moving existing services when the cost of that re-provision has not been calculated.”