In its advisory report to the OFT, Monitor raises doubts about the merger’s benefit on:

  • Haematology services
  • Emergency departments
  • Acute general surgery

    The report says due to potential changes to services by health commissioners, the departments are already likely to alter and adapt without the merger.

It also raises concerns about cardiology, based on an ongoing review of these services, saying any benefit is likely to be time limited and only affect a small category of patients.

However, it does say proposed changes to maternity may improve the service by eliminating patient transfers and increasing midwife cover at Poole.

In general, Monitor criticises the lack of sufficient detail about how the benefits will be realised in services other than cardiology, emergency, acute general surgery, haematology and maternity.

Monitor also said the financial savings had not been “sufficiently” evidenced and that back office savings could be achieved through a number of different means.

The report is supported by the OFT, which has competition concerns about 17 clinical specialities.

These include:

  • Rheumatology
  • Rehabilitation
  • General medicine
  • General surgery
  • Geriatric medicine
  • Clinical haematology
  • Dermatology
  • Palliative medicine
  • Cardiology
  • Oral surgery
  • Cardiothoracic surgery

The OFT also has concerns about:

  • Medical oncology
  • Gynaecology
  • Vascular surgery
  • Neurology
  • ENT (ear nose and throat)
  • Trauma and orthopaedics

These concerns are due to “insufficient evidence” to support the trusts’ contention that they did not already compete over these specialities.

The OFT report states it does not consider other hospitals in the area strong enough competitors to constrain the merged organisation in the future, again citing a lack of evidence to persuade them otherwise.

Throughout the document, there is an emphasis on whether the merger would lead to a reduction in incentives to improve the quality of hospital services.