Accident and Emergency Departments

Christopher Chope Excerpts

Tuesday 10th September 2013 Commons Chamber

[Mr Hunt]

As I recall, the risk register for that period found its way into the public domain. As for our publishing the risk register, we are following exactly the same policies as the hon. Gentleman’s Government followed in office. They refused to publish that register for the simple reason that officials need to be able to give Ministers frank advice in private if Ministers are to do their job properly. That is why we have not changed the policy.

[Mr Christopher Chope (Christchurch) (Con)]

The Royal Bournemouth hospital accident and emergency department treats 70,000 patients a year. Will my right hon. Friend explain how it can possibly be in the interests of those patients for that department to be downgraded to a minor injuries unit?

[Mr Hunt]

The changes that my hon. Friend alludes to are locally driven and have not crossed my desk. I want to reassure him that if they do cross my desk, I would not approve them unless there was convincing evidence that that was in the interests of patients and there had been proper consultation.

Tobacco Packaging

Christopher Chope Excerpts

Friday 12th July 2013 Commons Chamber

[Anna Soubry]

The hon. Gentleman knows that he and I do not agree on this matter. Of course, we have not made a decision; that is the whole point. We are waiting to see the evidence as it emerges from Australia before we make a decision. I am more than happy to meet him again, as I have done in the past, but I can tell him: I am not going to meet those whose business is to trade and to manufacture tobacco. It is bad; it is horrible stuff. It kills people. It does great damage to people’s health.

[Mr Christopher Chope (Christchurch) (Con)]

I draw attention to my entry in the Register of Members’ Financial Interests.

I congratulate my hon. Friend on her indecision. I also draw to her attention the fact that there does not seem to be any evidence that the sale and availability of illegal drugs in plain packages has reduced their attractiveness to young people.

[Anna Soubry]

I could speak for a very long time about illegal drugs and how we make them less attractive to young people. We know, for sure, that we need a subtle mixture of different measures that persuade young people not to take substances that are harmful to them. I am more than happy to have that conversation with my hon. Friend.

Health and Social Care

Christopher Chope Excerpts

Monday 13th May 2013 Commons Chamber

[Mr Robert Walter (North Dorset) (Con)]

I would like to talk on two issues that, although not included in the Queen’s Speech, will come before the House in this Session, one of which needs to be addressed with some urgency.

In 2005, the European Court of Human Rights ruled that Britain’s automatic blanket ban on the right of prisoners to exercise their vote was incompatible with the convention on human rights, of which we are a signatory. Almost eight years on, the United Kingdom has still not acted on that ruling and time is running short. The Government must submit their response to the Council of Europe’s Committee of Ministers by 30 September. We have less than five months to prepare and present a formula that will be not only satisfactory to the Committee, but acceptable to Parliament and credible in the eyes of the British public.

I would like to state from the outset that I disagree with the ECHR ruling. I believe that the current ban on prisoner voting, which was ruled on and reinforced by successive Parliaments, is a proper and proportionate response following conviction and imprisonment, and I spoke and voted accordingly when the House last debated this matter. I repeat that to my mind the right to vote is not an intrinsic right, but a civic duty reserved for responsible citizens. However, we cannot talk of individual duty and responsibility in the eyes of the law while shirking our national obligations to uphold the international rule of law, one of the basic tenets of British foreign policy. Here is the troubling paradox: if, as the old maxim goes, no man is above the law, surely no country is either. I welcome the fact that this Government, unlike their predecessors, have recognised this responsibility, and I am pleased that the draft Bill on prisoner voting has been presented and that a Joint Committee will consider its options, but I am concerned that matters are progressing slowly against a swiftly approaching deadline and that we are not making a strong enough case for a pragmatic solution.

If the Government choose to maintain the status quo, we will stand in breach of the convention. If we ignore the judgment, we send the message that dissent is an acceptable state of play, and we would damage our reputation and lose the moral authority to demand compliance from those countries that persistently violate international law. Do we want our record on observing the rule of law compared with that of Russia, Ukraine, Turkey, Azerbaijan and Armenia? It would be neither right nor desirable, but a solution might be closer to home than we think.

Before the blanket ban came into force under the Representation of the People Act 1969, limited forms of prisoner voting were permissible and even practised. The Forfeiture Act 1870 disqualified convicted felons from voting, but only those serving a sentence exceeding 12 months. Felons serving less than 12 months could legally vote, and where it was practically and logistically possible, some indeed did. In the 1950 general election, for example, postal ballots were returned from prisoners in jails across the country.

There is more. When the Criminal Law Act 1967 abolished the distinction between felonies and misdemeanours, the concomitant disqualification on prisoner voting came temporarily to an end. In fact, all prisoners could vote. In effect, these prisoners had the right to vote, and it might surprise people that this was not an unintended consequence of the legislation, but a conscious decision based on a recommendation by a law review committee that the practice of prisoner disfranchisement should not continue.

That policy continued until a ban was introduced in 1969 under the Representation of the People Act, but the point is that the issue was not historically set in stone—not under the Forfeiture Act and not when the United Kingdom signed the convention in 1950—so past precedents should lead the way. To this end, the Government’s proposals on minimum thresholds are worthy of consideration, as they reflect an approach that was deemed compatible with UK law, public opinion and the convention, but we need to step up the dialogue.

How, then, do we move forward? I believe that the distinction between felonies and misdemeanours is obsolete, but the classification of crimes into indictable and summary offences, which distinguishes between grades of crime, mode of trial and punishment available, continues to apply. Like the old felonies, the most serious indictable crimes are tried before a Crown court, and I believe that this distinction could be used as a building block for a sentence-based solution that recognises the gravity of an offence committed. This is a route that we should consider, and the United Kingdom now has an advantage: the European Court recently reaffirmed its commitment to allowing the UK greater flexibility in how we apply the ruling, providing an opportunity to develop a policy that reconciles both principle with pragmatism and which allows our past to pave the way forward.

[Mr Christopher Chope (Christchurch) (Con)]

I think my hon. Friend has made a constructive contribution, but would he accept that what he is saying is totally at odds with what the people of this country believe? They do not want prisoners to have the vote and they do not see why European judges should be bossing them around and telling them otherwise.

Oral Answers to Questions

Christopher Chope Excerpts

Tuesday 26th February 2013 Commons Chamber

[Mr Hunt]

If we are to learn the lessons of the Francis report and admit to our mistakes, perhaps the right hon. Gentleman will reflect on the fact that, because we decided to protect the NHS budget, there are 8,000 more clinical staff in the NHS today, yet he still wants to cut the NHS budget from its current levels, as he confirmed only last December.

[Mr Christopher Chope (Christchurch) (Con)]

T3. In today’s edition of the Daily Express, the Prime Minister promises to prevent immigrants freeloading on our NHS. Words are one thing, but can the Secretary of State spell out exactly what actions will be taken to deliver on the Prime Minister’s pledge?

[Mr Jeremy Hunt]

I am happy to confirm to my hon. Friend that we intend to take some profound steps in this area, because we have a national health service, not an international health service. We have to ask whether it is appropriate for us to be giving free health care to short-term visitors, to students, to people on temporary visas. We will be saying more about that issue shortly.

Social Care Funding

Christopher Chope Excerpts

Monday 11th February 2013 Commons Chamber

[Mr Hunt]

All the Barnett consequential issues are decided by the Treasury, and we will of course comply with them.

[Mr Christopher Chope (Christchurch) (Con)]

Is it possible to have some transitional arrangements, because four years is a long time to wait for a family who are already paying care costs? Is it not possible to increase the capital allowance, for example by £20,000 a year, from now on? Is it not possible to allow care costs in excess of £75,000 to be set against future inheritance tax?

[Mr Hunt]

I understand where my hon. Friend is coming from. All I can say is that we had very strictly to produce a package that is affordable within the current financial constraints. For that reason, we have come up with the package we have. It is the earliest we think we can afford to do this and the lowest cap we think we can afford, but I will of course reflect on his comments.

NHS Trust Merger (Dorset)

Christopher Chope Excerpts

Thursday 22nd November 2012 Commons Chamber

[Mr Christopher Chope (Christchurch) (Con)]

May I first thank Mr Speaker for selecting this subject for this evening’s debate? I am delighted that my hon. Friend the Member for New Forest East (Dr Lewis) and my right hon. Friend the Member for New Forest West (Mr Swayne) are here. My right hon. Friend the Member for New Forest West has himself sent a submission to the Office of Fair Trading in relation to the proposed merger of the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust with Poole Hospital NHS Foundation Trust.

This is not just an important subject for our locality. It raises issues of principle, because this is the first time it has been proposed that two separate NHS foundation trusts merge. The OFT says that there a lot of other proposals in the pipeline. It is therefore important that the Minister has the opportunity to comment on what seems a bizarre procedure, certainly in relation to this matter.

I have to express an uncomfortable truth about tonight’s debate. I have always trusted the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust as being open, transparent and honest in its dealings with me and the public at large, and my constituents appreciate the excellent services provided at the two hospitals. However, it is fundamental to public confidence in hospitals that there should be transparency and openness in dealings with the public. Indeed, the requirement for such transparency and openness is set out in the documents on which the foundations trusts are based. The constitution of the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust describes it as a “public benefit corporation”, and paragraph 6.5 states:

“In conducting its affairs, the Trust shall have regard to the need to provide information to members and conduct its affairs in an open and accessible way.”

As I shall demonstrate, in relation to the merger proposal, quite the reverse has happened.

I also refer my hon. Friend the Minister to another trust document, “Authorisation of the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust”. It was approved on 1 April 2005 by Monitor. Paragraph 25, headed “Information given to Parliament and to Members of Parliament”, reads:

“In addition to any statutory requirements, the Chairman, Chief Executive or any other person giving information to Parliament or to a Member of Parliament on behalf of a Trust shall ensure that they comply with the standards expected of Ministers of the Crown with regard to openness of dealings, the giving of accurate and truthful information and the correction of any inadvertent error at the earliest opportunity. Any question submitted to the Trust by a Member of Parliament shall be responded to by the Trust within the same timescale as that expected of Ministers with respect to Parliamentary questions.”

In due course, Mr Deputy Speaker, you will see that the trust seems to be totally in breach of that paragraph.

The trust has embarked on a merger proposal. Obviously, with any such proposal, people will wonder, “What is the purpose of the merger? Why do we need a merger? What will be the benefits and consequences?” I found out that the trust had produced a long document setting out the benefits. In order that I could respond to the Office of Fair Trading inquiry, I thought it would be helpful to see the benefits case, and I eventually received an almost totally redacted version, dated September 2012. The section on the key patient benefits to cardiology starts on page 29, but almost every line on every page is completely redacted. The same is the case with the sections on acute general surgery, haematology and maternity services—indeed, the only word that is not redacted in the latter section, which is four pages long, is “maternity”.

That is scarcely credible. It is farcical and makes a complete mockery of any public consultation or involvement. The OFT has the task of trying to find out from local people and third parties whether they believe that patient benefits flowing from the merger will outweigh the loss of choice and competition that will inevitably result, but the basic information needed to reach a judgment is not available. That is why I am in a state of limbo. We had only 14 working days to send in our submissions to the OFT, so I sent in mine on the basis of as much information as I could gather on the grapevine, plus some speculation, pointing out how aggrieved I felt, on behalf of my constituents, that the information needed was not made available.

The OFT is now considering the issue and will, I am told, announce its decision by 8 January 2013. I hope that at the end of this debate the Minister will say to me that, on behalf of the Government, he will ask the Office of Fair Trading, as I have, to refer the matter to the Competition Commission for a full inquiry, because it raises lots of issues. It also makes it difficult for the Office of Fair Trading if the information provided to it cannot be tested in public.

That is where we are at the moment. I received that heavily redacted document, and instead of anything else I was then given a set of slides, which caused me to raise a number of questions. I put them in writing to the hospital and at the end of last week, after about a fortnight, I received replies to them. However, the letter I received, dated 16 November, starts:

“Dear Chris

Strictly private and confidential. Not to be disclosed without express prior written consent of both Poole Hospital NHS Foundation Trust and the Royal Bournemouth and Christchurch Hospitals NHS Trust”.

I therefore cannot disclose what the document says—I think I can disclose that it exists and I can tell the House what some of the questions I asked were, but the answers cannot be shared. One of the questions was:

“Why do services have to be reduced in the absence of a merger ‘in order to stay viable’?”,

but I am not allowed to publish the answer. I also asked:

“In the event of no merger, which services will no longer be provided locally which will thereby necessitate patients having to travel further?”,

and so on. I asked all those questions, but the answers—if they can be described as such—cannot be made available. Surely that must a breach of the terms of the constitution to which I referred earlier.

The process is far from satisfactory, but let me turn to the substance. After a considerable amount of digging and discussion with local people, I found out why there is this conspiracy of secret dealings. The Royal Bournemouth and Christchurch Foundation Trust knows that it is under an obligation, under section 242 of the National Health Service Act 2006,

“to engage and/or formally consult when considering changes to the way in which services are provided or the range of services they intend to provide”.

The trust wants a service reconfiguration, but it wants to close down the options before any public discussion of it takes place. The trust effectively wants to pre-empt discussion by using the cloak of the merger proposal. As a unified trust—a monolithic monopoly supplier—it would then effectively be able to dictate terms to the Government and the local people. For example, reducing the Royal Bournemouth hospital’s accident and emergency service from a 24-hour, seven-days-a-week service to one operating between 8 o’clock in the morning and 10 o’clock in the evening could be presented as a fait accompli, as could closing down the maternity service, which is a midwife-led service, and transferring it to Poole because Poole is desperately short of money.

One of the issues behind all this is that for years the Royal Bournemouth has prided itself on wanting to be the hospital of choice for local people, but then Poole hospital got into financial difficulties—indeed, it did not have its accounts properly accepted for 2010. It seems that the only way Poole hospital can get out of those difficulties is by merging, because then it would have a higher prudential borrowing limit, which would enable it to carry out improvements. However, my point is this: what is the benefit for the people using the Royal Bournemouth and Christchurch hospitals at the moment?

There has also been an attempt to try to intimidate people and prevent them from participating in any public discussion. I have had a number of discussions with people involved in the governance of the hospital, and with other local residents. I shall not quote from all the letters that I have received, but I do have one letter that I thought would be worth quoting. It is from a lady who says:

“I am very impressed by your investigations into the planned merger, which once completed will suddenly and too late wake the slumbering populace up. I really wonder who the NHS thinks they are there for—it seems only, sometimes, for themselves and their accountants. And to issue our MP with heavily redacted information is bordering on Stalinism.”

There is a notice up now in the local hospital, saying that there is legal advice against disclosing the benefits case, and restating that no decisions have been made regarding the reconfiguration. But the issue is not decisions; it is about proposals, and it is the proposals about which we should be having a discussion. If I asked my independent foundation trust for information, I should not have to receive a letter back from the two foundation trusts jointly. They should be looking at the matter from the point of view of the interests of each of their localities, rather than having a joint exercise, which is squeezing out the public interest.

The notice continues:

“The benefits submitted to the OFT have had full engagement with lead clinicians across both hospital trusts around how the new organisation could move forward”.

I do not quite know what “full engagement” means, but obviously if there is no public declaration of what the benefits are, nobody is in a position to know whether it reflects their views. That is one of the fundamental reasons why we support the principles of accountability in this House.

I hope that when the Minister responds to the debate he will deal with the issue of accountability. I am hopeful also that, in looking at the whole case, he will have regard to the comments that he made when he responded to a debate on acute and emergency services on 26 October. On that occasion, our hon. Friend the Member for Bracknell (Dr Lee) was arguing for nationally led service reconfiguration, but the Minister pointed out that changes to services in Manchester and London, which had been cited, were

“driven at a local level by good clinical leadership and effective engagement of local communities.”

It is the latter part of that which is totally lacking currently in Christchurch, Bournemouth and Poole. In the same debate, my hon. Friend emphasised the need for plans for service change to be developed in a way that

“gives confidence to local communities.”

He also emphasised that change

“should encourage choice and availability”

and identified the danger that in the more rural parts of the country,

“bigger and better centres will often reduce choice”

and result in people having to travel

“long distances to receive their care.”—[Official Report, 26 October 2012; Vol. 551, c. 1271-2.]

The Minister also referred to the advent of clinical commissioning groups taking over from primary care trusts, but there has been no engagement between those groups and Members of Parliament about what is being proposed in Christchurch, Bournemouth and Poole.

That is where we are at the moment. I think it is very sad that there has been that breakdown in communication between the Members of Parliament and the trusts. The whole purpose of the trusts—I was delighted when the Royal Bournemouth was one of the first foundation trusts, established in 2005—was that they should be independent and could not be interfered with by Government, but would be accountable to local people. But I am afraid that the local people, even those who are serving in positions on the board, are feeling that they are being squeezed out of the debate, being told that they must not say anything for fear of prejudicing the outcome. Surely this very important proposed merger should be the subject of a public debate, and before we get to the stage of a merger the proposals for the reconfiguration of services, which are obviously being actively discussed and debated by the chief executives of the two trusts, should be put before the general public for their views. I do not think that my constituents are very keen on the idea that their accident and emergency unit, which they use, at the Royal Bournemouth should be closed after 10 o’clock at night and not reopen until 8 o’clock in the morning. Likewise, I do not think that they are very keen on the idea of the maternity service being relocated from Bournemouth to Poole.

Anyone who asks questions about the merger is told that if it does not happen, Poole hospital will close. A similar threat was made to me on Monday when I went to the hospital. I was told that if the merger did not go through, Christchurch hospital would close. That is completely at odds with a letter that was sent to one of my constituents who had expressed concern about the changes at Christchurch hospital. In that letter, the hospital stated that, because of the financial strength of the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, the future of Christchurch hospital was assured. That letter was received by my constituent earlier this month, yet the chief executive told me on Monday that if the merger went ahead, the proposal for Christchurch would be abandoned and Christchurch hospital might have to be sold. What an extraordinary state of affairs we are in! I look forward to hearing from my hon. Friend the Minister. I hope that he will be able to allay some of the concerns in our locality.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

It is a pleasure to respond to the debate. I congratulate my hon. Friend the Member for Christchurch (Mr Chope) on securing it, and on being a strong advocate for the needs of his constituents and of patients throughout his part of the world. I also pay tribute to my right hon. Friend the Member for New Forest West (Mr Swayne) and my hon. Friend the Member for New Forest East (Dr Lewis), who are also in the Chamber. They, too, are strong advocates for the patients they represent, and I know that their constituents are grateful to them for that.

It is right to highlight the importance of having a good working relationship between Members of Parliament and their local hospital trusts. It is never desirable for any hospital to embark on local service changes of any kind without properly engaging with the local Members of Parliament. In this case, we are talking about a merger, rather than a service reconfiguration; there is an important distinction between the two, which I will come to in a moment. Nevertheless, from what my hon. Friend the Member for Christchurch has said, it does not sound as though the local hospital trust has engaged with him in a way that we would all consider desirable, and I am sure that it will consider that in its future relations with MPs.

That point was strongly made when my hon. Friend read out the heavily redacted document. There is freedom of information, and certain issues can quite rightly be exempted from freedom of information requests under statute. However, to present a document bearing only the heading “Maternity” is not in the spirit of co-operative and collaborative working with Members of Parliament or in the spirit of being as open and transparent as we would like. I am sure that he has already raised these issues locally, but I would also like to place on record my concern at what he has told the House. It is important that MPs, as strong advocates for our constituents and the patients in our constituencies, should always be engaged at an early stage when decisions of this magnitude are being made.

My hon. Friend paid tribute to the dedicated front-line staff at the hospitals in Poole and Bournemouth. It is worth highlighting that some very good things have been happening in both trusts. At Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, a life-saving service that treats heart attack patients within 60 minutes is now available 24 hours a day, seven days a week at the Royal Bournemouth hospital. It treats heart attack patients from across Dorset, Hampshire and Wiltshire. Also, a new combined acute and rehabilitation stroke unit opened in 2012. It is designed to improve the experience and outcomes of stroke patients by providing specialist services, with a particular focus on the rehabilitation of patients, which is an important part of stroke care.

[Mr Chope]

I am glad that the Minister cited those examples, but are they not examples of how independent trusts can innovate and thereby create beneficial change rather than have a monolithic monopoly? Surely we would not have so much innovation if all our trusts were merged into one.

[Dr Poulter]

My hon. Friend is right that trusts—in their own right, or when they are merged together as they were historically over the river at Guy’s and St. Thomas’ and at the medical school of Guy’s, King’s and St. Thomas’ of which I am a graduate—can gain and improve the quality of care available to patients without losing their distinctness. Services are offered on each site, but at the same time they can add to the services they provide to patients in the totality. I believe my hon. Friend is right to say that these innovations have come from the independence and the good work of his local hospital, but I also believe there can be distinct advantages from hospitals coming together as well. The common purpose is making sure that good local service provision is maintained, while services of clinical excellence are also developed, further improving the offer to patients—not just in those towns, but throughout the area.

I want to highlight, and not leave out, some of the good things happening at Poole hospital, as it would be wrong for me, having highlighted a number of good developments at the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, not to mention them. At Poole hospital, the standard of care for cancer patients has been rated as among the best in the country in a national survey. The 2011-12 national cancer patient experience survey found that 94% of patients rated their care as “excellent” or “very good”, giving Poole the highest score recorded among participating trusts. I know all Members, as constituency Members, would feel very proud of that hospital’s achievements.

I am sure that my hon. Friend welcomes this Government’s investment in the NHS, even in very difficult economic times, as we put an extra £12.5 billion into NHS services over the lifetime of this Parliament. I am sure we all agree that that is a good thing.

What is the current position? Let me address some of my hon. Friend’s points. As to the proposals by the foundation trusts in Bournemouth and Poole, I appreciate that when any changes to local NHS services are mooted, people can become anxious and feelings can run high. However, I must be very clear to my hon. Friend that there is no formal role for Ministers or the Department of Health in approving mergers between two foundation trusts. I fully appreciate his concern to ensure that there is appropriate engagement and consultation on any proposals for service changes that may affect his constituents. I have already put on record some of my concerns about the process and engagement so far, which I think we would all accept is not ideal.

[Mr Chope]

I was not asking the Minister to have a role in approving the merger or otherwise. What I asked him to do, on behalf of the Government, was to say to the Office of Fair Trading that this is an issue of sufficient significance that it should be referred to the Competition Commission.

[Dr Poulter]

If my hon. Friend will be patient with me for a few moments, I will address that point a little later.

In acknowledging the understandable anxiety that can be stoked when any discussions about hospital services take place, it is important to highlight the fact that, as we saw over the river at Guy’s and St. Thomas’, although there was some good preservation of the individual and distinct offers to the local populations of the two institutions in their own right, by coming together they have been better together and provided better services.

One of the big problems we face in the NHS is concern about putting more money into front-line care and about cutting back on waste and bureaucracy. Clearly, if the administration across two trusts can be shared, it will free up more money to be diverted and put into what we all care about—front-line patient care.

Let me put on record once again that the trusts have clearly stated that this is not about the reconfiguration of clinical services. That is quite distinct. My hon. Friend was quite right to mention some of the points I raised in reply to my hon. Friend the Member for Bracknell (Dr Lee) about the important and distinct challenges faced in rural constituencies, and the fact that service reconfiguration challenges are very different in rural areas where there are longer distances to travel. As I have said, however, this is not about reconfiguring services, but about trusts merging and seeking what I think we would consider to be potentially desirable results, such as economies of scale and a reduction in unnecessary administrative burdens when possible. I think that, although the process and the approach taken to engagement with my hon. Friend and other Members of Parliament have not been ideal, some very positive elements have emerged from the discussion.

As my hon. Friend said, stringent tests would be applied to reconfiguration if it were on the table. The criteria would be strong public and patient engagement, consistency with current and prospective need for patient choice, a clear clinical evidence base, and support for proposals from clinical commissioners. Clinicians should always lead reconfiguration challenges, but today we are not talking about reconfiguration; we are talking about a hospital merger. It is the first of its kind to be proposed between foundation trusts in the country, and in that respect it is new territory for the NHS. There are distinct rules, including, as my hon. Friend said, referral of the case to the Office of Fair Trading.

The OFT’s role in reviewing the merger will be to establish whether there is a realistic prospect that it will result in a substantial lessening of competition. I am sure that it will also consider the issues of rurality and the choice of services available to patients. Should it refer the matter to the Competition Commission, which it has a right to do if it has concerns, the commission’s role will be to conduct an in-depth investigation, and to decide whether the merger does indeed represent a substantial lessening of competition and choice.

Concern has been expressed about the rurality of surrounding areas, and about the fact that there are long distances between hospital trusts. That may—