Monitor seeks solution to competition impasse

Chief executive David Bennett said that the proposed solution could see Monitor playing a greater role in looking at mergers at an early stage – and the OFT, and the planned Competition and Markets Authority, taking greater note of its views.

He hopes Monitor’s involvement could reduce the chances that a proposal would be subject to a full assessment by the Competition Commission – potentially holding up necessary changes.

The move comes as a final decision is awaited on the planned merger between Poole Hospital Foundation Trust and the Royal Bournemouth and Christchurch Hospitals Foundation Trust. The Competition Commission has called for more evidence of the benefits of the merger after finding it would lessen competition.

Mr Bennett told an HSJ/Capsticks roundtable: “I want to see whether we can agree… that we will get involved at an early stage with a view to advising whether the proposed action makes sense from a foundation trust governance point of view but also from a competition view.”

The aim would be to get to the point where if proposals did need to go forward to the OFT there was a high likelihood of being compliant with the rules. Monitor was discussing with the OFT and CMA – which is due to take on some of its functions in April – whether they would “take significant note” of what it said about any proposals.

“I am hoping that we will get to a place where the merger partieswill only be proposing things that the OFT/CMAare comfortable with and will reach a conclusion quite quickly.”

NHS England chief executive Sir David Nicholson said recently that competition law was standing in the way of improvements to NHS services – and the law might have to be changed to enable service changes to proceed quickly. He also called for politicians to “get out there” and support service change.

But Mr Bennett – who defended the role of competition in the NHS but stressed it was only one of a range of mechanisms available to drive up quality – was sceptical about whether politicians would be courageous.

“You called for political courage and I have given up on that,” he told the other panel members. “It is not going to happen. I think politicians will follow public opinion. The challenge that all of us in this room and many others face is to talk directly to the public. I think the group the public will most listen to are clinicians.”

The roundtable also heard from Foundation Trust Network chief executive Chris Hopson and Poole chief executive Chris Bown. Both said it was unlikely the government would address the issue through legislative changes, such as an amending the Enterprise Act to give the health secretary the power to override decisions by the competition authorities.

The two men backed Mr Bennett’s proposed solution, however Mr Hopson said Monitor needed a better balance between its foundation trust governance function and its role as a market regulator.

“Yes [to] a greater role for Monitor but if it’s basically Monitor in its current role we would be quite concerned because at the moment Monitor seems to be behaving very much like the OFT and Competition Commission,” he said.