Press release: Birmingham hospitals merger cleared by CMA

The Competition and Markets Authority (CMA) found that, whilst the merger between Heart of England NHS Foundation Trust (HEFT) and University Hospitals Birmingham NHS Foundation Trust (UHB) could give rise to competition concerns across a number of elective specialties, these were outweighed by the substantial improvements to patient care that were expected to arise.

In reaching this view, the CMA has placed significant weight on the advice on probable benefits from NHS Improvement, the sector regulator, which strongly supports the merger.

NHS Improvement advised the CMA that HEFT had experienced sustained difficulties in governance, quality of care and finances since 2012, which successive management teams had been unable to address.

It also advised that the appointment of the UHB management to HEFT’s executive team in October 2015 has already given rise to a number of benefits, such as reduced waiting times and improvements in the quality and safety of patient care for all HEFT patients. However, these improvements and a number of other longer-term benefits would disappear without the merger and the continued presence of the UHB management at HEFT.

The CMA found that HEFT would be a relatively weak competitor to UHB without the merger and that both parties were experiencing capacity constraints.

The CMA compared this to the wide-ranging nature of the benefits identified by the hospitals and NHS Improvement, which would benefit most patients at HEFT. It also examined UHB’s track record and the results already delivered at HEFT since October 2015.

On the basis of the available evidence in this case, the CMA found that the benefits put forward by the hospital trusts outweighed the CMA’s potential competition concerns.

The merger will therefore not be referred for an in-depth investigation.

Kate Collyer, Deputy Chief Economic Adviser and the decision maker in this case, said:

We have found this merger will have substantial benefits to the healthcare of patients in the Birmingham and Solihull local area.

This is the first time the CMA has cleared an NHS hospital merger on the basis of patient benefits at phase 1 and reflects the quality of the benefits case put forward in this instance and the consistent and detailed advice of NHS Improvement.

The hospitals involved presented clear evidence and a well reasoned case.

Competition currently plays a limited role in the NHS, as health commissioners and regulators have instead emphasised co-operative working to handle growing demand for NHS services.

However, given the scale of the potential impact on patients in Birmingham and Solihull, it was appropriate for the CMA to examine this transaction to determine whether any loss of choice or competition would be outweighed by improvements undertaken by the Parties and overseen by NHS Improvement.

All other information relating to this investigation can be found on the case page.

Notes for editors

  1. The CMA is the UK’s primary competition and consumer authority. It is an independent non-ministerial government department with responsibility for carrying out investigations into mergers, markets and the regulated industries and enforcing competition and consumer law. For more information on the CMA see our homepage or follow us on Twitter @CMAgovuk, Flickr and LinkedIn. Sign up to our email alerts to receive updates on merger cases.

  2. Under the Enterprise Act 2002 (the Act) the CMA has a duty to make a merger reference, resulting in an in-depth phase 2 merger investigation, if the CMA believes that it is or may be the case that a ‘relevant merger situation’ has been created, or arrangements are in progress or in contemplation which, if carried into effect, will result in the creation of a relevant merger situation; and that the creation of that situation has resulted, or may be expected to result, in a substantial lessening of competition (SLC) within any market or markets in the United Kingdom for goods or services.

  3. Under the Act a relevant merger situation is or will be created if 2 or more enterprises have ceased or will cease to be distinct enterprises; and the value of the turnover in the United Kingdom of the enterprise being taken over exceeds £70 million; or as a result of the transaction, in relation to the supply of goods or services of any description, a 25% share of supply in the United Kingdom (or a substantial part of it) is created or enhanced.

  4. At phase 1, if the CMA is of the view a merger raises a realistic prospect of an SLC it must refer the merger for a phase 2 investigation, unless an exception to the duty to refer applies. Section 33(2)(c) of the Act allows the CMA to exercise its discretion not to refer a merger giving rise to a realistic prospect of an SLC for a phase 2 investigation if it believes that relevant customer benefits in relation to the creation of the relevant merger situation would outweigh the SLC concerned and any adverse effects resulting from it.

  5. The CMA notified NHS Improvement when it decided to carry out an investigation under the UK merger control rules, pursuant to section 79 of the Health and Social Care Act 2012, which applies to mergers involving NHS foundation trusts. NHS Improvement provided advice on the effect of the merger under investigation and this will be published on the case page as soon as is reasonably practicable.

  6. UHB operates the Queen Elizabeth Hospital, and HEFT operates from 3 main hospitals and a smaller site (Birmingham Heartlands Hospital, Good Hope Hospital, Solihull Hospital and the Birmingham Chest Clinic).

  7. The CMA’s role is to examine the impact that the merger could have on patient choice and the quality of healthcare services provided by the merging trusts. The CMA undertakes an evidence-based assessment of the effects of NHS mergers on competition and aims to ensure that such mergers do not result in lower levels of quality of healthcare services for patients.

  8. The CMA has found that in 25 elective specialty services the merger could reduce quality for patients by removing the incentives that currently exist for the trusts to attract patient referrals from each other. In Birmingham, there is limited choice for patients to go to other local hospitals, with the merger reducing the number of competing hospitals trusts from 3 to 2. The 25 services represent less than 15% of the revenue of all services provided by the Parties.

  9. This is the first phase 1 hospital merger case that has been cleared on the grounds that relevant customer benefits will outweigh any adverse competitive effects arising from the merger.

  10. The text of this decision will be placed on the case page in due course.

  11. Media enquiries should be directed to press@cma.gsi.gov.uk or call: 07774 134814



Press release: PHE highlights 8 ways for local areas to prevent mental ill health

Public Health England (PHE) has today (30 August 2017) launched a ground breaking new tool for local public health teams identifying the most cost effective mental health programmes. One of these 8 initiatives is an innovative resilience programme in schools that results in an estimated saving of £5.08 for every £1 invested (over 3 years).

The tool was developed in partnership with leading economists at the London School of Economics and Political Science (LSE). The programmes it identifies are proven to reduce the incidence and/or risk of mental health problems at all stages of life: children and young people, the working age population and older people. Mental health problems represent the largest single cause of disability in the UK. The cost to the economy is estimated at £105 billion a year.

The full list of programmes identified in the Return on Investment tool are:

  • Children: whole school anti bullying programme – every £1 invested results in an estimated saving to society of £1.58 (over 4 years)
  • Children: social and emotional learning – every £1 invested results in an estimated saving to society of £5.08 (over 3 years)
  • Workplace: wellbeing programme – every £1 invested results in an estimated saving to society of £2.37 (over 1 year)
  • Workplace: stress prevention – every £1 invested results in an estimated saving to society of £2.00 (over 2 years)
  • Collaborative care for physical health problems – every £1 invested results in an estimated saving to society of £1.52 (over 2 years)
  • Older people: tackling loneliness through volunteering and social activities – every £1 invested results in an estimated saving to society of £1.26 (over 5 years)
  • Adults: debt and welfare service – every £1 invested results in an estimated saving to society of £2.60 (over 5 years)
  • Adults: suicide prevention – every £1 invested results in an estimated saving to society of £2.93 (over 10 years)

Alongside the tool, PHE has published several other evidence-based resources that will help local areas create effective public health systems that can prevent as well as treat mental ill health.

Duncan Selbie, chief Executive at Public Health England said:

A lot of mental health illness can be prevented, this will not only improve the quality of life of the individual but also provide economic benefits by reducing the financial burden of mental ill health, which has been estimated to cost the UK £105 billion a year.

In order to provide a truly 21st century response to this important public health issue we have to give equal attention to the prevention of mental ill health as well as treating it.

Health Minister Lord O’Shaughnessy said:

Improving the nation’s mental health is a government priority.

The tool and resources published today will give public services the evidence they need to ensure spending on mental health is as cost effective as possible.

It is part of a broad and ambitious plan to combat mental illness, which includes the first ever access and waiting time standards and record levels of public spending on mental health provision.

Professor Martin Knapp, Director of PSSRU at LSE said:

From our research in this field, there is good evidence for these (and other) interventions for mental health promotion and prevention. Our work, led by David McDaid, has concentrated on the likely returns on investment that adopting these interventions will make and bring to local areas. This work is good news for mental health and good news for encouraging a focus on prevention alongside care and treatment.

The tool and other resources are an important turning point in moving towards a more prevention focussed approach – helping those who are experiencing challenges to their mental health and also helping to improve mental health within local communities.

In order to achieve this movement action is required not just from the health, social care and public health sectors but also the community and voluntary sectors to give more attention to the wider causes of mental health problems including health inequalities and wider social determinants.

Major health bodies have thrown their support behind preventing mental ill health, signing a statement of intent. The Prevention Concordat for Better Mental Health has also been published today and is signed by agencies including NHS England, the Local Government Association, NICE, the Faculty of Public Health and Association of Directors of Public Health.

PHE exists to protect and improve the nation’s health and wellbeing and reduce health inequalities. It does this through advocacy, partnerships, world-class science, knowledge and intelligence, and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health. www.gov.uk/phe. Follow us on Twitter @PHE_uk

Professor Brian Ferguson, Chief Economist at Public Health England said:

One in four adults experience at least one diagnosable mental health problem in any given year. 10% of children aged 5 to 16 have significant mental health difficulties. By investing in interventions for children, the workplace, adults and older people we can support people throughout the course of their life and prevent common mental health conditions.

£105 billion a year figure taken from: NHS Five Year Forward View for Mental Health February 2016

The full list of resources published by PHE today:

  1. Prevention Concordat for Better Mental Health: consensus statement

  2. Prevention Concordat for Better Mental Health: prevention planning resource for local areas (PHE) is a practical guide developed to support local areas across England to put in place effective arrangements to promote good mental health and prevent mental health problems.

  3. Prevention Concordat for Better Mental Health: prevention planning resource for local areas and overview infographic

  4. Prevention Concordat for Better Mental Health: local planning resource summary

  5. Stocktake of local strategic planning arrangements for the prevention of mental health problems: summary report (PHE and Kings Fund) is a high-level summary of how local areas are currently incorporating mental health promotion and prevention of mental ill-health in their planning processes. The stocktake was based primarily on a content analysis of key planning documents in 35 local areas, including a random sample of 16 areas across England and 19 areas selected as possible examples of good practice.

  6. Mental Health and Wellbeing Joint Strategic Needs Assessment Toolkit: knowledge guide (PHE) complements the Mental Health Joint Strategic Needs Assessment Online Profile which is designed to support local Health & Wellbeing Boards in developing Mental Health JSNAs. It brings together nationally available data on mental health prevalence, risk and protective factors and healthcare services

  7. Commissioning cost-effective services for promotion of mental health and wellbeing and prevention of mental health problems (PHE and LSE) summarises the findings of modelling work to estimates the cost of investing in several different interventions for which there is evidence that they can help reduce the risk and/or incidence of mental health problems in individuals of different ages and/or promote good mental health and wellbeing.

  8. Barriers and facilitators to commissioning cost-effective services for promotion of mental health and wellbeing and prevention of mental ill-health (PHE and LSE) examines some of the barriers and facilitators to the implementation of actions to promote better mental health and wellbeing and prevent mental health problems.

  9. Mental Health Promotion Return on Investment Tool and tool guide (PHE and LSE) reports the Return on Investment to health and other sectors from investment in 8 different interventions to promote better mental health and prevent the development of mental health problems. Results can be tailored to local settings. The guide provides users with step-by-step instructions and guidance on how to use the Mental Health Promotion Return on Investment Tool.

  10. Psychosocial pathways and health outcomes: Informing action on health inequalities (PHE and UCL Institute of Health Equity) provides a conceptual framework that focuses on the psychosocial pathways between factors associated with social, economic and environmental conditions, psychological and psychobiological processes, health behaviours and mental and physical health outcomes.

For further information contact:



Speech: “Peacekeeping is one tool in the sustaining peace toolbox. It cannot be used in isolation…”

Statement by Ambassador Jonathan Allen, UK Deputy Permanent Representative to the United Nations, at the Security Council open debate on Peacekeeping and Sustaining Peace

Thank you Mr President. And thank you to the briefers for their insightful contributions. And let me also, through the Deputy Secretary-General today, thank the women and men of the UN around the world for their service and courage.

The UK aligns itself with the upcoming statement of the European Union.

Mr President, conflicts rarely follow a predictable path. We must move beyond the idea of a set of sequential responses, which is why the United Kingdom supports the Secretary-General’s vision for a more holistic and inclusive approach to conflict prevention, management, and resolution. Sustaining peace requires that all of the UN system is aligned in every context and able to carry out multiple tasks simultaneously.

I would like to focus on two issues today related to sustaining peace. The first is on how peacekeeping missions should be situated within wider UN efforts.

At the most basic level, the starting point for any peacekeeping mission should be from all of the information gathered by the UN family over the years including what the UN has already achieved in the field. It should be clear what peacekeeping missions will deliver with UN partners during their deployment and how. And how they will hand over to other UN actors when they leave. For example, the peacekeeping mission in South Sudan may be the second largest in the world – but it is also only one of 20 UN bodies and agencies represented in the country.

We in this Council must reflect on these questions during mission mandating and planning. We need to take in clear views and understanding ground truth from the field. The Council must be more disciplined in setting out strategic goals which can be translated through mandates into prioritised objectives, benchmarks for success, and plans for mission draw-down once these have been achieved.

On the ground, the whole of the UN should have a joint analysis of the situation, common objectives, and clarity over roles and responsibilities towards meeting them. In the context of Liberia’s transition, a shared peacebuilding plan has gone some way towards achieving this.

Moreover, a better balance of responsibilities between missions and country teams needs to be struck. Not every conflict driver can be addressed within the lifetime of a peacekeeping mission. Long-term change is best supported by UN country teams. They should be taking on responsibilities much earlier, not waiting until a mission draw-down looms. Important lessons will soon emerge from the Democratic Republic of the Congo and Darfur, contexts where more may be asked of country teams.

And support from the top is needed for an integrated approach. The coordinating role of the Strategic Planning and Monitoring Unit in the Executive Office of the Secretary General is a welcome start. It will enable more integrated analysis and a more coherent cross-United Nations review of activity in country. We would like to see the unit regularly reviewing peace operations and look forward to its contribution to the review of MONUSCO. Mr President,

Peacekeeping missions cannot create the conditions for their own exit without a sustainable political solution to conflict. As such, the second issue I would like to focus on is the primacy of politics.

SRSGs need to be politically active, using their good offices and leveraging support from their missions and the wider UN system. We must accept that missions are political tools in themselves, both representative of the will of this Council and in their actions on the ground.

The tasks of peace operations are never merely technical. For example, the re-establishment of effective states often sits at the centre of mission exit plans. But missions cannot improve the functioning of state institutions without an understanding of how these institutions will be used and by whom. Politically blind capacity-building efforts risk worsening the situation.

UN country teams, integrated into the wider effort, also have a role to play in promoting sustainable political solutions. Greater understanding of who does and does not benefit from development programming, and how this is linked to political dynamics, is critical. And let’s face the facts: where political regimes are unaccountable, unresponsive to their own people, and unrepresentative – including of women – appeals to national ownership will ring hollow.

Finally, we in this Council must be politically engaged and ready to speak. A Council united around a shared political strategy to de-escalate tensions could have a powerful effect. But even in the face of flagrant violations of its resolutions, the Council too often finds itself deadlocked and unable to act. Gertt Rosenthal noted that the Security Council rarely acts to prevent conflict. My own short experience here has shown that we are not willing to act, even when as in South Sudan, there has been conflict for five out of the six years of the country, a third of the populations is displaced, half are in food insecurity, and UN resolutions and promises made, have been repeatedly broken.

Mr President,

Peacekeeping is one tool in the sustaining peace toolbox. It cannot be used in isolation and we are seeing progress towards more integrated approaches. But even the most coherent UN response will still be blunt without attention to the primacy of politics. And here, we have further to go.

Thank you Mr President.



Press release: Sir John Bell to unveil industry-led proposals to build UK’s status as world leader in life sciences

  • Sir John Bell outlines findings of independent sector-led review into £64 billion life sciences industry at University of Birmingham
  • the review will inform the basis of government work with the sector towards a Sector Deal in the coming months
  • Business Secretary Greg Clark and Health Secretary Jeremy Hunt will also announce details of £160 million of funding to support the sector including the NHS

Industry proposals to help the UK’s life sciences sector become an international benchmark for success will be unveiled by Professor Sir John Bell during a speech at the University of Birmingham’s Institute of Translational Medicine later today (30 August 2017).

Attended by Business Secretary Greg Clark and Health Secretary Jeremy Hunt, Sir John Bell will outline the industry’s vision for how government can work alongside the sector to boost businesses large and small across the £64 billion life sciences sector.

In the government’s Industrial Strategy green paper, launched in January, life sciences was one of five of the UK’s leading sectors tasked with working with stakeholders across the industry to identify opportunities for how government can support the industry.

The industry-led Life Sciences Industrial Strategy follows Sir John Bell’s comprehensive cross-sector review into the long-term future of the industry and brings together input and recommendations from a broad range of stakeholders, including global companies such as AstraZeneca, Johnson and Johnson, MSD, GSK and healthcare groups, SMEs and charities.

The report’s recommendations will be considered carefully by the government and used to work towards a sector deal between government and the global life sciences sector.

Sir John Bell is expected to say:

The vision for the Life Sciences Industrial Strategy is an ambitious one and sets out proposals for how the UK can continue to capitalise on its strengths in the sector, both to encourage economic growth and to improve health outcomes for patients.

We have created a strategy which capitalises on our strong science base to further build the industry into a globally-unique and internationally competitive life sciences eco-system, supported by collaboration across industry, government, the NHS, academia, and research funders to deliver health and wealth.

I look forward to working with government to consider the strategy’s recommendations, including those that can be taken forward as part of an ambitious sector deal.

From a cross-section of industry and trade association members of the Life Sciences Industrial Strategy Board:

We welcome the publication of the Life Sciences Industrial Strategy, led by Sir John Bell. The Strategy and Board demonstrate the breadth and vibrancy of the life sciences ecosystem in the UK, the importance of collaboration across the sector, the critical role of the NHS in delivering the development and use of new medical technologies, and the contribution of our sector to the UK economy.

The Strategy provides a holistic and collaborative framework to realise the many exciting opportunities in the future of life sciences in the UK and is a positive first step to cementing the success of our sector.

This should provide the springboard for any sector deal for the life sciences sector, including the NHS and other stakeholders; this will be vital to ensuring that the recommendations set out in this Strategy are fully implemented.

As the UK leaves the EU, collaboration with, and support from government is more important than ever to maintaining the UK’s position as a global life sciences ecosystem.

The Life Sciences Industrial Strategy, a report to the government from the life sciences sector, is organised under 5 key themes – science, growth, NHS, data, and skills – with proposals to build on the UK’s strengths in each area. These include:

  • Science – Reinforcing the UK science offer by sustaining and increasing funding for basic science to match our international competition and by further improving UK clinical trial capabilities
  • Growth – Improving growth and infrastructure across the country, through a tax environment that supports growth and by attracting substantial investment to manufacture and export high value life science products of the future
  • NHS – Encouraging NHS collaboration by recommending the Accelerated Access Review be adopted with national routes to market streamlined and clarified, including for digital products
  • Data – Making better use of data and other evidence by establishing 2 to 5 regional innovation hubs that would provide data across regions of 3 to 5 million people.
  • Skills – Ensuring the UK has the talent and skills to underpin future life sciences success by delivering a reinforced skills action plan across the NHS, commercial and third sectors

The Strategy also recommends the establishment of the Healthcare Advanced Research Program (HARP), a programme through which industries, charities and the NHS can collaborate on ambitious and long-term UK-based projects to transform healthcare and take advantage of the medical trends of the next 20 years.

Health Secretary Jeremy Hunt is expected to say:

The UK has always been at the forefront of scientific excellence. From the discovery of antibiotics to our world-leading 100,000 Genomes project, we have a proud history of medical breakthrough and innovation.

I want patients to continue to be at the front of the queue for the best treatments available, whether that means early access to trials, giving staff brand new innovations and technology to work with, or being at the heart of research to share best practice quickly across the health and social care system. A strong and growing life sciences sector ensures this, particularly as we negotiate our exit from the EU.

In welcoming the Life Sciences Industrial Strategy, the Health Secretary is also announcing £14 million funding to support 11 medical technology research centres to encourage collaboration between the NHS and industry in developing and bringing new technologies to patients through the National Institute for Health Research (NIHR). This will mean patients will continue to benefit from new technologies which will help to improve diagnosis and get them the treatment they need quickly.

Business Secretary Greg Clark is expected to say:

The life sciences sector is of critical importance to the UK economy and UK health – with over 5,000 companies, nearly 235,000 employees and a turnover of £64 billion in 2016 – and the government is committed to continuing to help this sector go from strength to strength.

The Life Sciences Industrial Strategy demonstrates the world-class expertise the UK already has in this sector and represents the industry’s vision for how we can build on our world-leading reputation in this field.

We will be engaging with Sir John Bell in the coming months in an effort to work towards a sector deal that helps us seize the opportunities in this area.

Chief Executive of Innovate UK, Dr Ruth McKernan, added:

I know from my own experience that the UK is a world leader in life sciences. These new proposals underline our strength and will keep the nation at the cutting edge. At Innovate UK, we look forward to playing a key role in its delivery.

Working with the research community and exciting companies, with equally exciting ideas, we will drive innovation to create new jobs and deliver greater productivity.

At the launch of the Life Sciences Industrial Strategy, the Business Secretary will reiterate government’s commitment to the sector, announcing the first phase of the government’s investment in life sciences through the Industrial Strategy, with £146 million for leading-edge healthcare, which is expected to leverage more than £250 million of private funding from industry.

This investment, part of the government’s flagship Industrial Strategy Challenge Fund, will be spread over 4 years and covers 5 major projects supporting advanced therapies, advanced medicines and vaccines development and manufacturing. These projects are:

  • Medicines Manufacturing Innovation Centre: A £13 million competition to establish a new centre, in partnership with industry, that will accelerate the adoption of emerging and novel manufacturing technologies
  • Vaccines Development and Manufacturing Centre: To develop and manufacture vaccines for clinical trials and prepare for emergency epidemic threats, government is investing £66 million in a new centre of excellence
  • Advanced Therapies Treatment Centre £30 million investment in 3 new sites will help establish a network of centres, based in hospitals, that will transform the UK’s ability to develop and deliver cell and gene therapies to a large number of patients
  • Expanding the Cell and Gene Therapy Manufacturing Centre: Enhancing the UK’s offer in the fast-moving field of cell and gene therapy by investing £12 million in doubling the capacity of the Cell and Gene Therapy Centre in Stevenage
  • Research and Development to support innovation at the manufacturing centres: Through a new collaborative scheme, the government is investing £25 million to support SMEs working in this sector and boost innovation

Government has increased investment in research and development over the next 4 years by £4.7 billion to create jobs and raise living standards through the Industrial Strategy Challenge Fund. The Business Secretary has announced that the first £1 billion of investment is being made in 6 key areas in 2017 to 2018, driving progress and innovation that will create opportunities for businesses and sectors across the UK.

The NIHR Medtech and In vitro diagnostic Co-operatives (NIHR MICs) build expertise and capacity in the NHS to develop new medical technologies and provide evidence on commercially-supplied in vitro diagnostic (IVD) tests. The NIHR MICs will provide funding over five years for leading NHS Organisations to act as centres of expertise; bringing together patients, clinicians, researchers, commissioners and industry. 11 centres across England have been designated NIHR MICs.

The Life Sciences Industrial Strategy Board members quoted above include the:

  • Association of British Healthcare Industries
  • Association of the British Pharmaceutical Industry
  • AstraZeneca
  • BioIndustryAssociation
  • GlaxoSmithKline
  • Immunocore Ltd
  • Johnson & Johnson
  • MSD
  • Northern Health Science Alliance Ltd

The full Board brings together representation from across the sector, including industry, academia and charities.



News story: Green light for lorry ‘platooning’

The UK’s first HGV ‘platooning’ trial, jointly funded by Highways England and the Department for Transport, has been given the green light.

Overseen by Highways England, TRL (the UK’s Transport Research Laboratory) will carry out the trials, which will see how lorries can accelerate, brake and steer in sync through wireless technology.

Jim O’Sullivan, Highways England’s Chief Executive, welcomed the announcement, and stressed that safety will be an integral part of the trials:

We are pleased to be supporting the government’s ambition for the UK to be a global leader for innovation.

The trial has the potential to demonstrate how greater automation of vehicles – in this instance, HGVs – can deliver improvements in safety, better journeys for road users and reduction in vehicle emissions.

Investing in this research shows we care about those using our roads, the economy and the environment, and safety will be integral as we take forward this work with TRL.

Members of the public should contact the Highways England customer contact centre on 0300 123 5000.

Journalists should contact the Highways England press office on 0844 693 1448 and use the menu to speak to the most appropriate press officer.