Mid Staffordshire – the way forward

Quality of care Regulation

In October 2012, Monitor appointed a Contingency Planning Team (CPT) to assess the sustainability of Mid Staffordshire FT (MSFT) and develop a long-term plan. The CPT’s interim report concluded that, despite improving clinical performance, its small scale means it is both clinically and financially unsustainable in its current form.

The CPT then went on to propose that Stafford Hospital should be downgraded, its services halved and without a 24/7 A&E.  With some minor changes to Cannock Chase Hospital this made a “two local hospitals” solution.  The hospitals will be transferred to other providers and an exercise has begun to invite expressions of interest in the delivery of services; current, protected or an alternative set.

The Trust is being run by 3 Joint Trust Special Administrators (TSA) for MSFT who have taken over the role of the Board and the FT Governors and who must propose and consult on the way ahead. We must all hope this attempt at a “failure” regime is better managed and thought through than the total shambles that is happening in South London/Lewisham.

The situation in Staffordshire must be seen as an opportunity, not a response to “failure”.  Local stakeholders have to be guided through a process to honestly explore sustainable long term solutions to problems which will impact across many other parts of the country. How to redefine the role of “hospitals”; how to have systems, staff and processes fit for 21st century; how to reduce demand for acute hospital in-patient care; how to move care closer to home; how to integrate services across NHS and social care; how to move to a well-being approach rather than a reaction to illness approach.

The recommendation for a cost cutting short term reactive approach will get no support and will potentially not be implementable.  Pandering to ill informed opinions and opportunist political interventions will do nothing to improve care in Staffordshire.

The troubled history of Stafford hospital is largely irrelevant to possible solutions; so far as anyone can judge the quality of care at Stafford is good.

What is significant however is the likely impact of the Francis Report and how the system generally and hospitals in particular have to respond.  What is also obvious is that cutting staff, failing to listen to staff and having a staff that is disengaged and demoralised will lead to poor care.  Continuing denigration of staff and suggestions of solutions involving a “25% reduction on staffing” to solve the MSFT “problem”, will be strongly resisted by those who genuinely seek safe, sustainable and high quality care.

A solution to the long standing problems in Staffordshire must be found, backed by stakeholder agreement, and found quickly – further argument and disagreement just does further harm.

A whole system solution should be an NHS solution, where the best of the knowledge and experience of the NHS are applied to finding solutions – not a market and failure approach where support from other parts of the NHS might be ruled anti-competitive or indeed resisted by NHS organisations looking to benefit from any failure of competitors.  We need NHS experience not paying further millions to management consultants to state the obvious.

A sustainable solution will require new thinking, it will take time and cost money and needs effective management of the transition and of the system as a whole. The various organisations have to be made to work together not compete and squabble over the carcass of MSFT. A sustainable solution will not come through applying the principles of the market.