NHS competition holds up creation of specialist cancer treatment centres

NHS competition holds up creation of specialist cancer treatment centres Hospitals block reorganisations by claiming mergers are anti-competitive and would reduce patient choice.

The government's drive to introduce more competition into the NHS is having the perverse effect of holding up the creation of world-class cancer treatment centres, the Observer can reveal.

Investigations show that individual hospitals whose roles would be downgraded under reorganisations are blocking moves to concentrate cancer services into fewer top-performing specialist centres, by claiming such mergers would be anti-competitive and would reduce patient choice.

NHS leaders, who are deeply concerned about the effect that legal disputes are having on progress, have admitted some cancer units are being allowed to carry on operating even though they do not meet the latest official guidelines on how services should best be organised.

In one case, a "rationalisation" of cancer services in and around Manchester, proposed by NHS England as a way to improve "outcomes" to world-class levels, is being challenged and held up by complaints from south Manchester NHS foundation trust and Stockport NHS foundation trust on legal grounds.

The health regulator Monitor is now involved in a detailed investigation into whether the changes contravene government regulations introduced in April this year, supposedly to widen competition and choice. The Manchester dispute is one of several affecting different aspects of healthcare across the country.

Former Tory health secretary Stephen Dorrell, who now chairs the all-party select committee on health, suggested patients' lives were at stake, and called on NHS England to drive through the improvements and make sure patient care took precedence.

Ten days ago, the outgoing chief executive of NHS England, Sir David Nicholson, made known his frustration at the way competition disputes were holding up progress and costing hospitals many millions of pounds in legal fees. He told Dorrell's select committee that "we are in my view getting bogged down in a morass of competition law, which is causing significant cost in the system".

Nicholson added that the law may need to be changed to sort out the mess. "It is causing great frustration for people in the service about making change happen. That may be because of the way in which we are interpreting the law – we are talking to Monitor – but it may be because that is the law, in which case to make integration happen we will need to change it." He said Manchester was "not the only cancer service that is not meeting guidelines".

Dorrell, whose committee is recalling Nicholson for further questioning on this and other issues, told the Observer that the interests of patients should come first. "I am in favour of engagement with local clinicians and management, and it is obviously better to proceed by agreement. If however, as is the case in cancer care, there is well-documented evidence from all over the world that more concentrated facilities deliver better patient outcomes, it is the duty of the commissioner to insist that services change to improve outcomes for patients. Local motivation and engagement are important, but they are not more important than patients' lives."

Another Tory member of the committee, Sarah Wollaston, who is a GP, said: "It is utterly perverse for any doctor to use competition legislation to try to block restrictions on their own practice where there is clear evidence that cancer surgery concentrated in specialist centres saves lives. David Nicholson should set out where this is happening and what needs to change in the legislation."

The arguments come as the government tries to tackle the immediate crisis of growing waiting times and overcrowded A&E departments. Labour is arguing that former health secretary Andrew Lansley wasted three years and billions of pounds on unnecessary and costly reforms of the NHS, introducing more competition, rather than tackling the urgent need to treat more patients outside hospital.

A spokesman for NHS England said that in order to comply with official guidance from the National Institute for Health and Care Excellence, "some cancer treatment needs to be concentrated into a smaller number of providers, where clinical expertise can be consolidated".

She added that Nicholson had been making the point to the health committee that despite the improvements that such change could bring "it could be viewed as anti-competitive" by opponents. The Guardian