The merger of the Royal Bournemouth Hospital and Poole Hospital Trusts would result in a loss of choice for patients across “a large number of overlapping services,” the Competition Commission has said today.

In a provisional report published at 7am on Thursday morning, the Commission says a large number of overlapping elective inpatient (20) and outpatient (36) services provided by both trusts, as well as maternity services and private cardiology services would be affected.

The two trusts must now prove that the benefits of the merger outweigh the loss of choice for patients.

The evidence collated by the Commission has shown that patients—as well as GPs making referrals on their behalf—see the hospitals as the closest alternative to each other.

The Commission is concerned that patients would lose this choice, and the trusts would lose an important incentive to maintain or improve quality in order to attract patients.

The Commission has provisionally found that the merger is not likely substantially to reduce competition in supply of non-elective services, community services or in any future tenders by commissioners.

It says it does not believe that without the merger Poole would have to close, although it recognizes that it will face financial pressure in the coming years. It says other trusts will face similar pressures and that it is extremely rare for any trust to exit the market.

As well publishing provisional findings, the Competition Commission has published a notice of possible remedies to address the loss of choice.

Roger Witcomb, Chairman of RBCH/PH Inquiry Group and CC Chairman, said: “This is the first NHS merger which we have looked at and whilst we are conscious that there are important aspects of the NHS that distinguish it from other sectors, health policy has for some time been that patient choice has an important role in incentivizing hospitals to maintain and increase quality.

“The fact that they stand to gain or lose from patients voting with their feet is important.

“Our concern is that this merger would weaken this incentive across a wide range of the hospitals’ activities and remove one important driver of healthcare quality. Given the importance of this merger to the patients involved, we do owe it to them to examine its likely effects closely.”

He added: “It is now up to the trusts to provide evidence that the loss of choice for patients and the resulting loss of incentives to maintain or improve quality will be outweighed by benefits from the merger.

“We will evaluate all the evidence carefully and we will look to preserve any benefits in choosing a remedy. In order to take benefits into account, we will have to be convinced that such benefits are unlikely to be achieved without the trusts merging and may be expected to accrue within a reasonable period."

This is the first merger between two NHS foundation trusts to be examined by the Commission.

Andrew Christaki, RCN Regional Officer for Dorset and Wiltshire said: “This report will leave the community, including patients and staff at both Trusts, unsure of what the future holds.  This is of great concern to the RCN as staff and patient confidence are directly linked to the quality of patient experience which must remain at the heart of decisions made.”

In a joint statement, Tony Spotswood, Chief Executive at RBCHFT, and Chris Bown, Chief Executive at PHFT, said:

“The Trusts are bitterly disappointed that the interests of competition are being put before the interests of patients, their care, welfare and safety.

"The Competition Commission has a duty which is to assess whether the proposed merger will result in a significant lessening of competition. The two Trusts have emphasised that they provide complementary services, work together collaboratively, do not compete and wish to come together to protect and enhance services for patients and the residents of  Poole and Bournemouth.

“The Competition Commission asserts that the merger (with the number of management organisations reducing from two to one) will reduce patient choice. We refute this. We plan to maintain two viable hospitals.

“The likely prohibition of the merger will now create uncertainty about the future of services for the residents of east Dorset. The merger would have provided a basis to increase consultant delivered care, improve the quality of care and provided local people with new facilities for obstetric care, emergency care and treatment of cancer.

“The Trusts consider that the process is not fit for purpose and will be raising this at the highest level.”

The Trusts will now consider fully the contents of the CC’s provisional findings before responding.