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Ashford and Surrey merger delayed by competition watchdog

The Competition and Markets Authority (CMA) has referred a proposed merger of two hospital trusts in Surrey for an “in-depth investigation”. 

Ashford and St Peter’s Hospitals NHS Foundation Trust and Royal Surrey County Hospital NHS Foundation Trust made their formal submission to the CMA in December 2014, and were hoping that if the regulatory approval process had been successful there was a potential go-live date of this autumn for the merger. 

But, the CMA says the bid could result in “adverse effects” for patients by reducing choice and competition across a range of elective specialties, it says. 

In several elective specialty services (six inpatient and seven outpatient markets) the merger could “significantly reduce quality” for patients by removing the incentives that currently exist for the trusts to attract patient referrals from each other. It has now referred merger to a second assessment phase, which will take around six months to complete. 

The six affected inpatient markets are: ENT, Breast Surgery, General Surgery, Oral and Maxillo-Facial Surgery, Medical Oncology and Gynaecology; and the seven outpatient markets are: ENT, Joined Oral and Maxillofacial Surgery, Breast Surgery, General Surgery, Joined Audiology and Audiological Medicine, Medical Oncology and Gynaecology. 

Both trusts have stated their disappointment, but will continue to work alongside the CMA. 

Suzanne Rankin, chief executive at Ashford and St. Peter’s Hospitals, said: “Although this was not the decision we were hoping for, we understand that the CMA needs to carry out a more in-depth analysis of our plans to ensure this is in the best interests of patients. Unfortunately this means we will need to wait longer until a final decision is reached.” 

During the initial approval process, Monitor has provided advice to the CMA on the relevant customer benefits expected to result from the merger. It advised that the merger was likely to give rise to benefits in relation to rota reconfigurations to allow for seven-day working in three specialty areas (stroke, interventional radiology and gastroenterology) and these reconfigurations would result in improved emergency care and quicker discharge for more than a 1,000 patients. 

But, on the basis of the available evidence, the CMA in its initial view has not found that the benefits outweigh its concerns relating to the potential loss of competition. 

Andrea Coscelli, executive director of markets and mergers at the CMA, said: “Our job is to look at the evidence and examine the impact that a proposed merger could have on patient choice and the quality of healthcare services provided. 

“Tens of thousands of patients a year are treated by the trusts in the specialties we’ve looked at and could be potentially affected by the loss of choice they currently have.  

“We acknowledge that there may be some benefits which result from the merger but given the extent of our concerns and the number of specialties and patients involved, we feel it is necessary to look at this merger in greater depth to ensure that it is in patients’ interests.” 

Nick Moberly, chief executive at the Royal Surrey County Hospital, added that he was disappointed with this decision as” we believe a merger would result in a number of positive benefits for patients”. 

He said both trust boards will be discussing the CMA decision at their respective meetings next week to consider what implications the referral might have for them, and “we will keep staff, patients and local residents up to date as soon as we have further news”. 

(Image: c. Stephen Kelly)

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