The planned merger between two Dorset district general hospital trusts has passed a key regulatory hurdle, with the Competition and Mergers Authority (CMA) indicating that the trusts may create a shared leadership team and introduce joint management of key services.

The CMA’s decision clears the way for the implementation of Dorset’s Sustainability and Transformation Plan, which requires Bournemouth and Christchurch NHS Foundation Trust and Poole Hospital NHS Foundation Trust to integrate many of their operations.

Speaking last month in an exclusive interview with Managers in Partnership, Bournemouth and Christchurch trust chief executive Tony Spotswood explained that “what’s been agreed is that Bournemouth will become the main emergency hospital for East Dorset, Poole the major planned [care] site – and that signals really quite profound changes at both hospitals in terms of how care will be delivered. Teams will have to come together to provide services across both sites.”

The “substantive merger” is now likely to take place between April 2020 and April 2021, Spotswood told MiP last Friday – though it has not yet been agreed exactly how the CMA will consider the request to merge. Meanwhile, on Monday 1 October the CMA gave its approval for joint management plans which, said Spotswood, involve appointing “a joint interim chief executive officer and chair and joint interim leadership for four services: emergency department, older people’s medicine, trauma and theatres.”

By centralising services, Spotswood explained, the trusts will be able to provide better consultant cover – improving patient care. “Teams will be significantly larger, and we’re aiming to provide consultant-delivered care 24 hours a day, seven days a week,” he said. “There’s lots of national and international evidence to show that if you can configure services in this way, fewer patients suffer morbidity and avoidable mortality also falls.”

The merger plans have been opposed by local campaigners in Poole, who brought a judicial review to challenge the loss of their local hospital’s A&E department. But they lost their case in early September, being turned down on every point – so their subsequent appeal looks unlikely to succeed.

In response to the campaigners’ concerns about increasing the journey times to A&E for residents on the western side of Bournemouth, Spotswood pointed out that those suffering from the conditions where time is most crucial – he cited heart attacks and aneurysms – are already brought to Bournemouth Hospital’s A&E department during “out of hours” periods. “So the most acutely unwell patients are already coming here, wherever they live in Dorset, and our outcomes for both vascular surgery and cardiology are excellent,” he said.

The two hospitals’ merger was first proposed in 2011, when it was knocked back by the CMA’s predecessor body, the Competition Commission.

This article draws on our full interview with Tony Spotswood, which also examines his work to improve staff engagement, explores his views on structural reform of the NHS, and draws out the lessons he’s learned during 19 years as the trust’s chief executive.