The first step in achieving a merger is to gain clearance by the Mergers and Competition Authority (CMA). The case for merger was put to the CMA a while ago. The process is that the CMA has a short time either to approve or to submit the case to more detailed appraisal. Today the CMA decided that there was 'a realistic prospect of a substantial lessening of competition in a number of inpatient and outpatient specialties' and therefore withheld a decision until more work is undertaken. This will take a minimum of 6 months and thus the merger proposal programme has been moved back 6 months including planned wide ranging engagement with the public which would otherwise have started in a few weeks.