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Volume 49 Number 3, March 2, 2019 ARCHIVE HOME JBCENTRE SUBSCRIBE

The need for the pro-social direction for society

Latest Merger of South Tyneside and Sunderland Hospital
Trusts Part of Corporate-Centred Direction for the NHS

Website image on the formal response of the Save South Tyneside Hospital Campaign to the merger

South Tyneside NHS Foundation Trust and City Hospitals Sunderland NHS Foundation Trust Boards agreed a merger in December 2018. They are working with their business case to get approval from NHS Improvement, with their target that the merger will come into operation on April 1, 2019. The Save South Tyneside Hospital Campaign is part of the movement among organisations, staff and members of the public who opposed the merger in an "engagement" process last year.

Among the concerns are that the timing of the merger was not a coincidence. It will facilitate the "Path to Excellence", the downgrading and closure of services at South Tyneside Hospital, by removing structures in South Tyneside such as governors and joint union representation that serve to protect staff and services, and that give the people of South Tyneside and Sunderland a louder voice in their respective Hospital services. Also, the overwhelming majority of Unison members, the largest union at South Tyneside District Hospital, had previously voted against the merger during the "engagement" process in an indicative ballot organised by the union. Both Trusts had referred to the merger as "removing unnecessary organisational boundaries" in making changes to services. The concerns on the merger have been ignored, with the Trust CEO Ken Bremner declaring that the merger had been "unanimously backed" by NHS partners.

Local people fund raising to support the legal battle to save hospital services in South Tyneside and Sunderland

What is clear is that there are increasing numbers of Trust mergers and takeovers in the NHS in England, like the one in South Tyneside and Sunderland, which are accompanying the increasing cuts to hospital budgets. These are being led and encouraged by the government, NHS England and NHS Improvement as part of their overall aim for the NHS, and they intend to try to remove all obstacles to this direction of travel. The "long-term plan" for the NHS, which was announced by Theresa May and NHS England on January 7, continues the whole direction for mergers and takeovers of smaller hospitals Trusts by larger ones and says they "will support trusts that wish to explore formal mergers to embed these benefits". The "long-term plan" also said "we propose to remove the Competition and Markets Authority's duties, introduced by the 2012 Act, to intervene in NHS provider mergers."

On January 19, twelve days after this announcement, the Competition and Markets Authority (CMA) [1] itself responded by publishing an Economics Working Paper entitled "Does hospital competition reduce rates of patient harm in the English NHSi [2]". The paper said that "hospital mergers in concentrated areas without offsetting clinical benefits could significantly increase rates of patient harm".

For example, the paper points out: "Our main estimate is that a hypothetical future merger between two geographically proximate hospitals would, on average and assuming no offsetting clinical benefits are unlocked by the merger, result in a 41% increase in harm rates. The magnitude of the effect is significantly greater where few competitors remain post-merger, and smaller when several alternatives for patients remain. This effect is robust to a number of alternative specifications and holds also when we consider in-hospital mortality."

The paper also justified the role played by the CMA in approving and preventing Hospital Trust mergers noting that "A previous merger proposal between two hospitals, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust and Poole Hospital Foundation Trust, was prohibited by the Competition Commission in a much debated decision in 2013 on the basis of competition concerns and the absence of demonstrated benefits."

Following this, the Health Service Journal (HSJ) featured an article on February 4, 2019, entitled "Hospital mergers increase death and harm, CMA study says" [3], in which the journalist published the findings of the CMA working paper, saying: "Merging hospital trusts could increase mortality rates by up to 550 per cent and cause patient harm incidents to almost triple, new analysis by the Competition and Markets Authority has suggested."

The journalist goes on to explain that the CMA says its study "contributes further empirical evidence that competition ultimately benefits patients". The article counters this with an interview from Nigel Edwards, chief executive of the Nuffield Trust, who said that whilst "study had found a real effect" in an overall increase in deaths and harm to patients he claimed: "The conclusion that says a merger will increase death rates is completely illegitimate and an overextension of the analysis because there are other factors driving this." However, he does not throw any light on what he thinks these other factors were.

What is emerging from this is the incoherence of a corporate-led direction for the NHS. What the CMA study damningly exposes is that the government's "long term plan" for merging NHS Trusts is harming patient care and patient access to care and is not patient-centred but corporate-centred. The government wants to remove the intervention of the CMA from the Health and Social Care Act 2012 to ensure that these mergers and takeovers continue. But the claim that competition in health is the solution is also part of the incoherence and disinformation in the CMA report. The coherence must come from the people developing their resistance and taking up the responsibility to fight to safeguard the future of the NHS. The NHS needs a human-centred health care delivery system where health workers and people play a decisive role in these decisions as the new direction that must be taken.

[1] The Competition and Markets Authority (CMA) is a non-ministerial government department in the United Kingdom, responsible for strengthening business competition and preventing and reducing anti-competitive activities. The CMA launched in shadow form on October 1, 2013 and began operating fully on April 1, 2014, when it assumed many of the functions of the previously-existing Competition Commission and Office of Fair Trading, which were abolished. (Wikipedia)


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