Bosses still confident of NHS’ longest-running merger, despite delays

NHS chiefs in Dorset say the merger between Royal Bournemouth and Christchurch Hospitals Foundation Trust and Poole FT may not happen until October 2020. The trusts had initially hoped to become one organisation in April this year.

However, Debbie Fleming, chief executive of both trusts, said she was encouraged by the way the two trusts were working to deliver the “absolutely massive transformation programme” and added it would be very beneficial for the local population once it has been delivered. 

The merger is seen as vital to the success of a reconfiguration of acute services in east Dorset, for which the county’s integrated care system has been allocated £147m of capital funding from the Department of Health and Social Care. The reconfiguration involves centralising emergency care services in Bournemouth and converting Poole to a major elective hospital.

Delivering the merger has been complicated because the trusts need outline business case approval from NHS Improvement and NHS England for the capital project as well as the approval of the Competition and Markets Authority (CMA).

The CMA has previously told the trusts the outline business case for the capital funding needs to be approved before it will review a potential merger. Given that the approval process can take some time, there have been concerns from local chiefs that this will hold up the process.   

The plans have also been referred to the health and social care secretary Matt Hancock by two councils. Earlier this month, Mr Hancock passed the case to the Independent Reconfiguration Panel, which is expected to give its view in autumn.

Campaigners also brought a failed judicial review against Dorset Clinical Commissioning Group. 

Ms Fleming told HSJ there had – at one point – been a “high risk” of “going around in circles with everyone waiting for everything else”.

However, she said regulators had been “very supportive”, with NHSI agreeing to allow both pieces of work to be done “in parallel rather than in a linear way”.

The trusts have submitted their outline business case and hope it will be approved in November. If that happens, the trusts will then present their patient benefit case to the CMA. Ms Fleming said she believed the CMA could approve the merger by April 2020 and said the trusts are currently on course for that date, but added “there may be some slippage over the outline business case process which slows us down”. This means the merger may not be completed until October 2020, she said.

“We’re very confident that it’s going to move ahead as planned and we’re not too worried about the actual date,” Ms Fleming said. ”At the moment we’re using July 2020 as a proxy date. The sooner we can get on with it the better.”

The trusts first announced their intention to merge in 2011 but their application was blocked by the CMA, which was then called the Competition Commission.

However, this year, the CMA allowed the trusts to share the same chief executive and chair, and – more recently – authorised plans for the trusts to bring together seven clinical services (emergency, anaesthetics and theatres, older people’s medicine, trauma and orthopaedics, stroke, maternity and cardiac) and business support services, such as HR, finance and governance.

This involves staff working across both sites and starting to centralise the different services.

Ms Fleming said: “That is a huge difference to the last time, and it’s given great confidence to our staff and stakeholders that this is moving forwards. All of those things make people see and feel that it’s very different this time around.”

Ms Fleming said the building work required to deliver the reconfiguration in its entirety would not start until January 2021 at the earliest, as the trusts will also need to get a full business case approved next year. From that point, it could take up to five years to complete the reconfiguration.

Earlier this year, the CMA published a study which suggested reducing hospital competition significantly increases episodes of harm. 

Article updated at 6.22pm after it incorrectly stated OBC approval was dependent on the CMA approving the patient benefit case.