Mid Staffs and the great hospital scale-back?

Mid Staffordshire hospital is ‘unsustainable’, we are told. But is the controversy being used to test drive a dramatic scaling-back of hospital provision, especially for mothers and children, elsewhere in the country?

Diana Smith
23 December 2013

The complaints raised about Mid Staffordshire Hospital in 2007 sparked huge media and political interest, a series of investigations, reports, reviews, management consultants and inquiries. This imperfect process culminated in Mid Staffs being put into Administration earlier this year - one of only two hospital Trusts so far to undergo this fast-track process.

The Administrators report came out last week. Mid Staffs is now “unsustainable”, we are told.

Not in every respect, the Administrator admitted. He judged that Mid Staffs was operationally sustainable, in other words, that the service it was providing was now fine. His report goes out of its way to praise the tenacity and sheer hard work from the staff, in the face of years of pressure and uncertainty.

In fact Mid Staffs is now recognised as one of the 15 safest hospitals in the country. 

But - according to last week’s report - Mid Staffs is financially ‘unsustainable’ because it is running a deficit with no clear way of bringing this into balance within an acceptable period of time. 

And it has also been judged clinically ‘unsustainable’ in the long run, because - it is said - it does not serve a large enough population to allow the clinicians to develop & maintain their skills.

The detail of these rulings on Clinical and Financial sustainability should begin to ring alarm bells across the country.  

If the same logic is applied elsewhere, many hospitals that are just about coping at the moment are quite likely to cease to be “sustainable” in the near future. Particularly when you factor in the latest recommendations on 24/7 working.

The Administrator, assisted by Clinical Advisory Groups, has set a “direction of travel” for a small number of regional centres of excellence dominating the NHS, with District General Hospitals struggling to carve out a new identity for them – perhaps as diagnostic and rehabilitation centres, perhaps offering some form of end of life care.

This direction will no doubt be welcomed by a few ambitious large “centres of excellence” who see this as an opportunity for funding a major expansion of their facilities with a welcome injection of capital funding. But the impact on local hospital provision in towns and rural areas is worrying.

Many of us hoped that the Administrator would offer a way for mid-Staffs to become ‘sustainable’ and deliver a strong locally based service. The people of Stafford after the last 6 years are pretty knowledgeable about the complex challenges that the NHS faces and many would be prepared to work to develop a service that works for everyone. The Administrator’s recommendations give us many concerns.

The current consultant-led maternity unit is to be replaced with a midwife-led unit that can only deal with straightforward births. The Clinical Advisory Groups and the Litigation Authority have recommended that no maternity unit with less than 2,500 births per annum should be consultant-led.

If the decision on Stafford stands then we can expect to see the downgrades of a substantial number of maternity units throughout the country.

Whilst the plans are an improvement on the draft recommendation (for no maternity services at Stafford at all) it is likely to meet strong resistance.  Stafford’s Maternity unit has a very good reputation. Many of the services will rely on sharing staff between UNHS and Mid Staffs. It is not clear why this cannot apply to Maternity services.

And in fact there are indications from the head of UNHS that he will run the midwife-led unit as a four month trial only, after which it could still face the chop altogether.

The Intensive Care Unit is also to be downgraded - though again not quite as far as the original proposals. It’s unclear what range of operations and admissions the new unit will support, with individual clinicians to make a judgement about whether they can keep individual patients where they are.  But the unit will not be the ‘Level 3’ that is crucial to allow the hospital to work as an acute hospital.  

The proposals to close the Paediatric ward caused the greatest anxiety during the public consultation. The modified proposals allow for a “paediatric assessment unit”. It is still proposed to shut all the Paediatric impatient beds.

The thinking, we are told, is that it is wrong to admit children to hospital unless it is essential and that there needs to be a strong community based Paediatric service.

Indeed many of the Trust Special Administrator recommendations hinge on more care being delivered in the community, and better integration between primary, secondary and community based care, and the Social care sector.

But the community and social care services need to exist before the acute care can be scaled down.

I’ve watched the Mid-Staffs story develop since 2007.  I know that what is happening here will set a precedent that will be followed throughout the country.

The government will be throwing an astonishing amount of money at the Mid Staffs issue, enough to cover its deficit for decades.

So is this about providing a solution to Mid Staffs? Or is it more to do with the opportunity to test-drive the bulldozing through of reconfigurations in the face of local opposition?

We do need to think about what the future shape of the NHS should look like. But the Trust Special Administrator process is not the way to do it.



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