It’s been announced this afternoon that Monitor, the regulatory body for NHS Trusts, has begun the process of putting Mid Staffs NHS Foundation Trust (MSFT) into administration. Once this process is approved, which may only take a couple of weeks, the administrators of the Trust will have 150 days to come up with proposals from a range of options including the complete closure of the Trust. One option that is not included, however, is the continuation of MSFT in its current form.
Reports on the decision focus on the Trust’s financial struggles and Monitor‘s statement that MSNHS needs to cut costs by 7% in order to be financially viable.
Sounds like a serious situation, doesn’t it? But as its Annual Report almost a year ago showed, Mid Staffs was already embarked on a Cost Improvement Programme (CIP) to save 6-7% a year – and had achieved its target of £6.4m in the 2011/12 financial year.
Not only that, but the Trust’s board had already agreed a Clinical Services Implementation Plan (CSIP) to save 6% per year from 2012 to 2015. Cumulatively, this process would save far more than 7% – and, crucially:
within the plan is a three year financial strategy from February 2012 through to March 2015. The CSIP and financial strategy has been supported by the Trust Board and was approved by
Monitor, Commissioners and the DoH at a meeting on 30th January 2012
Just over a year ago, Monitor approved the board’s 3-year plan – yet now it has changed its mind and considers MSFT ‘unsustainable’.
Without question, MSFT is a ‘struggling Trust’ in financial terms. But it has been working to – and achieving – a plan that would bring it to a stable financial footing. A plan that was approved by Monitor and the Department of Health for 3 years and is now being cut short to put the Trust into administration.
This sudden change of ‘heart’ (if such a word can be applied to an organisation of which a witness at the Francis inquiry said ‘Monitor misses nothing – as long as it’s financial’) clearly gives away the intent behind the government’s apparent humility concerning the events at Mid Staffs, which was worrying from moment David Cameron ‘ate humble pie’ in his Commons statement about the Francis report.
Reports on MSFT unfailingly mention the myth that basic care failings at Mid Staffs resulted in ‘400-1200 avoidable deaths’ in the Trust’s hospitals – even though this claim was completely unfounded from the moment the Daily Mail and Daily Telegraph began to trumpet it, and even though the Francis Report itself does not support it.
Even the BBC have propagated the myth. The BBC News channel’s announcement of the administration decision began by referring to the Trust as a place where ‘hundreds of needless deaths’ took place, while the article on the BBC News website which I’ve linked above states:
This constant media focus on something that never actually took place is carefully fostered by the government in its language and stance – because it forms the cornerstone of a modus operandi, a method of operation, that the government is going to add to its general and pervasive assault on the NHS as a national, public institution.
The failures at Mid Staffs took place over a period that ended 3 years ago. The Trust now scores better than the national average in terms of its clinical outcomes and mortality statistics (correcting its statistical coding meant that it scored better than average on mortality even during the ‘problem’ period).
Yet only now, less than 3 weeks after the publication of the Francis Report, is Monitor choosing to put the Trust into administration – a decision that makes it extremely likely that the Trust will be broken up (or other Trusts around it will be broken up, as the government insanely did to Lewisham because of failings at South London).
Once the break-up is achieved, the hospital will either be handed over to private health companies to ‘save’, or else its services will be downgraded to simple, profitable ‘production line’ services such as hip and knee replacements (just as Jeremy Hunt announced will happen to Lewisham‘s successful hospital) – making it perfect for private companies to acquire and make money from without having to provide the complex, expensive treatments that we’re entitled to receive from true NHS hospitals.
If you’ve been wondering why Hunt and Cameron wrung their hands over the Francis Report and announced that 14 more hospitals have similar ‘death rates’ to Mid Staffs (though the stats for these are probably no more reliable than they were for MSFT) – wonder no more.
The over-eager rapidity of the decision to put into administration a Trust that is recovering in both financial and clinical terms betrays the government’s real agenda – the real reasons for their tactical posture on MSFT so far.
With an adverse spotlight once again on MSFT, and colluding media constantly ignoring the actual findings of the Francis report to foist the ‘unnecessary death’ myth onto a public that is ignorant of the facts, who is going to care if Monitor decides to put the Trust into administration. ‘Surely we’re better off without it, anyway?‘
Mid Staffs now. Then one by one the other 14 Trusts that have been targeted for the ‘unnecessary death’ slur will be systematically tarnished in the public consciousness by the collusive media, while ministers ‘regretfully’ advise that
we have to take steps to protect the public!
and, one by one, those Trusts too will come under Monitor’s baleful gaze.
Illusory problems will become ‘fact’, agreed 3- or 5-year plans will be trampled on, and we’ll suddenly find ourselves down by 15 hospitals – almost 10% of the total.
There are many fronts in the government’s all-out war on the NHS, but this one – the opportunity to take out 14 NHS hospitals that belong to us, the public – is a ‘wet dream’ for a party that has lusted for the destruction of Labour’s (and the UK’s) greatest achievement since it was founded.
Bevan said that the NHS would survive as long as there are people prepared to fight for it. This dishonest smear-campaign is the latest phase in the Tories’ attempt to distort the perception of the British public until there are none, or too few to mount an effective resistance.
We must not – must not – fall for the lies. Stafford is the battleground – and for all our sakes we need to stop the plan from succeeding there.
Reblogged this on patricktsudlow and commented:
The privatisation of the National Health Service will be a very backward step with dire consequences. welcome to Edwardian Britain, a hundred years on.
Some Mid-staffs factoids:
1) Monitor came up with many “estimates” for MSFT catchment (to demonstrate it’s small) eg 180,000 (still twice as big as Kidderminster). But the number of people who live closer to Stafford or Cannock hospitals (than any other) is 300,000 (with a land area of 300 sq miles) and MSFT does 0.46% of relevant workload which equates to 275,000 – even with the adverse publicity (probably be more without it).
2) CQC were sent in just before the Francis report came out, no doubt to rubbish the hospital – but couldn’t (all the patients and staff they spoke to were more than content). Likewise the TV/Press who were no doubt looking for suitable footage of current disgruntled patients – there weren’t any.
There’ll be more!
Ta
2)
Great info – thanks! MSFT website itself claims 260k (or 265k?), so much in line with your figures.
No doubt at all that this is a politically-driven move.
Reblogged this on HUMAN RIGHTS & POLITICAL JOURNAL.
Reblogged this on The Greater Fool.
Glad to see others picking up on the catchment area farce.
The hospital was built in early 1980s because after much local campaigning the people wanted to have a DGH (previously they had the old General Infirmary which is now an electrical goods warehouse). It was too far for people to travel from Cannock to Wolverhampton and Stafford to Stoke on Trent. Since then, the people of Stafford have been proud of their hospital, running for scanners and the like over the years. In the early 2000s pressure was placed to become a foundation trust. On the first application they failed, due to financial overspending although clinically the trust was highly rated. New management (ironically from New Cross) was installed with associated cronies and a 10 million saving was called for. Front line staff (mainly nursing were lost) and at some points the A&E was so undermanned that the local RAF doctors were drafted in. However, with previous clinical rating being high, the foundation trust status was won. The rest is history, but it was also an experiment – this was the first DGH to become a Foundation Trust. Still many teaching hospitals have not achieved that objective including the prestigious (although much higher SMR than Stafford) John Radcliffe in Oxford.
Now, it would appear the hospital has one of the lowest mortality indices (or more correctly, one of the most accurately coded set of patient turnovers) and is spending in line with what monitor had suggested last year. However, there most clearly is an agenda to destroy the Trust so that the nearby Trusts can take the patients and money/ private healthcare step in. Needless to say, this will be to the detriment of the local people. In the meantime, since Stafford hospital was built, the local population has boomed and the Trust now serves a catchment of about 300,000. The circulation of the 180,000 figure by monitor is disingenuous to say the least and would suggest alternative motives. One can only hope that this Trust is actually now supported along to continue the excellent progress it has made since the report. Closure or further downgrading of operation is not an option and we’re already seeing disaster stories from having an A&E that closes in the evening at the time most accidents happen. Monitor legally must provide a better service than the one currently offered, and sending the patients to Stoke (which is most unpopular with them as they are then transported back in the morning) is a moronic way to run things. Needless to say, most of the people of Stafford don’t like this very much indeed and very much want their hospital to continue in a current or expanded form.
Well it appears you may be right! The team sent in by Monitor have reported. Although the Special Administrator doesn’t have to follow this the temptation (since it’s likely to be a man in a suit) will be overwhelming because the main conclusions of the report are:
1) That Stafford and Cannock should become “local hospitals”(Cannock is already run as a community hospital so that’s irrelevant). In effect, Stafford would no longer be an acute hospital.
2) That the Critical Care Unit (CCU or Intensive Care Unit) would go, meaning that the hospital could not continue to offer many emergency and most acute services (see below).
3) That babies would no longer be born at Stafford.
4) That non-acute step up and step down beds (similar to a cottage hospital model – though most cottage hospitals have been shut) would be introduced.
(The slightly fatuous point is made that four out of five patients currently attending Stafford and Cannock would still go there (for outpatient appointments, tests, day cases) ie if it’s not worrying, painful or urgent it will still be local!)
You are therefore right that Secondary Care provision in Mid Staffs is a test case for up to 50 similar semi-rural or rural areas (and perhaps some buit-up ones if Lewisham is anything to go by) and by inference for equitable provision of healthcare for the more seriously ill in the whole NHS. This is a massive topic but some light may be shed if I provide some information from this area (I note the historical context provided by oldstaffordian which is, of course, relevant as the changes proposed will simply return Mid Staffs to the 1950’s).
“Operational Viability”
The regulator’s group tried very hard but in the end had to admit that MSGH was operationally viable ie capable of providing all the services to an appropriate standard and hitting all relevant targets. This shows what can be achieved (see below). To close such a (now) well run service for marginal (as you pointed out) financial reasons would be an obscenity under any system.
“Clinical viability”
This is based on the superspecialised model of care which is unnecessary in many DGH services and, for the most part, is not actually undertaken (see below). The Royal College of Physicians recently came to Stafford to meet the local MP’s group and were clear that an ITU (or as they are usually known nowadays – critical care units or CCUs) was a vital thing to retain – to support medical admission activity (as well as some elective surgery). You may have already have spotted why it would be a clever thing to close because it would make everything else difficult to do since the ultimate back-up isn’t on-site. I would also point out that CCUs (and Stafford’s is pretty good) do far more than simply have patients for “full” ITU care (artificially ventilated, lots of drips and machines, dialysis etc). They take patients for intensive monitoring and help with breathing short of full ITU care (and often these admissions are critical but short). Also they provide an outreach service to the wards where they assess and advise on the sicker patients at physician request. Often these patients do not need transfer to the ITU and certainly many patients recover and go home with help from ITU short of artificial ventilation. Naturally transfer to ITU for either level of care is more seamless if they already know the patient from outreach advice/help (in the eventuality that they do, nonetheless deteriorate). Accordingly if the ITU is closed down you lose all of this – and a very important part of the safety mechanisms for the illest patients – many of whom have an excellent chance of recovery. Almost all specialities would suffer if the ITU went and it may well compromise the viability of medical admissions altogether (and that is what the RCP people were saying). BUT there is also another key point about ITUs. They operate in regional and supra-regional networks so that if they are full, they stabilise the patient and effect a safe transfer from one ITU team to another. Our ITU is therefore also a cog in the regional ITU machine, not just a local facility.
Clinical non-viability was also argued on the basis of poor recruitment to consultant posts. Well considering the adverse publicity that wouldn’t be amazing would it (and an argument for less of it) but according to the Medical Staffing department the number of Locums in situ is at about the national average!
“Financial viability”
In a system which is marketised but the government sets the price of everything this is a bit of a circular argument but see points below.
Some further items and factoids:
Sorry got to go and collect my daughter so I’ll post this and send the rest of what’s in my head later.
Thank you – great info and I’m looking forward to the rest! I’m working on a post on Monitor’s decision and the implications for Staffs and for the UK, so if you can get your remaining points to me soon I’ll incorporate them.
Apologies for the break!
Can Stafford (with Cannock) provide Acute secondary care to Mid Staffs people?
Well that’s what is being done now and by objective criteria to a standard in the top quartile (at least) of Trusts. Not a time, one would think, to interfere with the good work. One can have an argument for particular niche services but the essential jigsaw can clearly be provided. As far as acute medical care (the most important to the elderly) is concerned what the RCP also clearly felt and said was that that they could work with the hospital to create a clinically viable Trust providing good local services (so do you believe the RCP or Monitor?) This might well be close to but not everything the public would like or feel is actually reasonable (and the clinical viability would probably result in financial viability given that other items being worked on of a non-clinical nature may well deliver (as per your previous blog) and even more so if some vertical integration happened – see below).
What about a merger?
Revelations recently from Stoke, Wolverhampton and Burton suggest that an ideal partner is not immediately available even if mergers were sensible. However, it has been tried a lot previously around the country without any hard evidence that it has worked. But with ample evidence that it is very disruptive and paralysing. Please, please do not be taken in by the argument that such mergers save money – they do not, either in the short or longer term (study by Bristol University’s Centre for Market and Public Organisation on the 4 year effect of English hospital mergers 1997-2003 – no changes in operating expenditure, detriment to patient care, access not measured but bound to be worse). Mid Staffs’ health economy has been paralysed enough by the time taken for the 2 Francis reports and the attendant press coverage – and therefore this is a particularly unacceptable outcome in this locality. It is very naive to suppose that the (long-suffering) people of Mid Staffs would be the prime consideration of any large superTrust (I think we can guess where the HQ would be, where most of the board would be from and where all the specialist units would be sited …. and ultimately where the single ITU and A&E would be (deep regret etc etc). As for an advantage being gained from re-branding – this is dishonest and the public won’t be fooled (it’s much more transparent to recover and be seen to recover without any jiggery-pokery like re-branding). Why not listen to Robert Francis on this point – needless re-organisations have been “counter-productive” (and you could argue that the NHS has been the most re-organised entity in the history of civilisation). If Francis2 is being taken seriously then developmental not structural solutions should be the order of the day – that is what he is saying. How can Stafford/Cannock maintain the momentum of quality improvement (from which the whole NHS might have something to learn) when a distraction like a superMerger happens?. So far the Trust hasn’t failed by Monitor’s agreed criteria (being predicted to fail later is hardly the same thing). You may wonder why they are involved at this stage at all. The answer is that the Board thought it was sensible to involve Monitor early on so everyone could agree on any necessary tweaks – meanwhile the rules changed and the Board has found themselves the Guinea-pigs for a process that didn’t exist when they asked for collaboration from the regulator.
What do ordinary people think?
Though my various comments (as opposed to factoids which I hope have also been helpful) are of course my own, they do reflect the feelings of practically all the people who live in this area who have ever brought up these subjects with me. You will only hear from a minority of current patients because they have their illness to cope with or feel overawed. This does not mean they do not feel strongly or that they will take kindly to being messed about with or subject to arrangements they don’t understand. I hardly need point out the magnitude of the fuss that surrounded the merger/downgrading of Kidderminster Hospital which had a natural catchment of 100,000. Mid Staffs is really a different order of magnitude and should realistically have services organised with its population and geography (325 sq miles – correction on 300 which I posted previously) in mind.
Is the Trust resistant to innovative solutions (short or long term)?
Because of staffing/safety issues a 14 hour A&E was brought in – implemented in less than 3 months about a year ago – a project that would make many private sector managers jealous. Now that A&E has been running a 14-hour service for some considerable time, do we have an evaluation? Not officially. Clearly there will be stories/instances where the extra travel/ambulance time is perceived to be critical (in some it will be true and tragic by all objective criteria and these cases are worth learning from [the public would conclude that a 24 hr A&E should come back – maybe they’re right though what they may be looking at is nothing at all]). There does seem to be a determination amongst patients, even those told in no uncertain terms otherwise, to get to Stafford (i.e. waiting until 8 am) rather than go out of the area. There is evidence that the numbers of patients who used to attend in 24 hours now don’t attend at all or attend in 14 (i.e. the walking wounded and unwell don’t wait but make a decision to get there before 10 pm or wait until 8) If so, the tremendous effort to make it work has been very good value. There is work towards direct admission of certain categories of (especially “known”) patients who become unwell in the night and this could be slowly expanded, leaving a limited number of patients to go elsewhere by ambulance (with the option of repatriation nearer home the next day, if able – another innovation which has worked well for some patients). Let me make one thing clear. The extremely limited number of extra patients taken by ambulance elsewhere (3-5 per hospital) has had a destabilising effect on them (that’s what they say, not us) – how will they cope with all the acute care from Mid Staffs?
Is there anything else that could make the whole thing “viable” even by the criteria applied currently?
What about more “vertical integration”? ie you combine the budget with the community services (or even GP services as well if you want to). The obvious advantages that could accrue from this (given that “more being done in the community” is the government’s desired direction of travel) include:
• We already have good working relationships with local community services and staff (and in many cases have known them for years) so we could build on that
• Likewise local GPs who would be heavily involved in decisions
• There would be no perverse incentives as currently (I save £100 in my budget but it costs you £200 or vice versa) – the Health economy would simply do for patients what was best or most efficient (or both!) without having to worry about “viability” or coming out on top (the purchasers are encouraged to purchase “integrated care” aren’t they?)
• MId-Staffs as a Health economy would be preserved – thus providing reassurance to the local population that their services are not going to be asset-stripped in favour of patients in another location – merely improved and integrated
• Innovative collaborations could be pursued on the ground (many hospital specialists and GPs have been gagging to do this sort of thing but inhibited by the fact that they are in different umbrella organisations) – it could well unleash a torrent of clinical collaboration that could reap dividends of the sort envisaged by the “Nicholson Challenge” (think of Palliative care where similar skill sets are being used in the hospital and community)
* The people we would be collaborating with would be local (not far to travel to meet them), who are also, of course (along with their families) users of local services, like us.
Is the (clinical/financial) position really as bad as is painted?
The Trust’s improvement almost proves that the situation is not far off sustainable. If the Trusts’s position can be “normalised” which is likely if there is an avoidance of structural change and with the final Francis report having been published, then attention can be given to reducing costs which need have no impact on clinical services (Cannock “rent”, HR/risk management etc, overheads compared to Peers).
There is also scope for development/expansion of certain services. Quite apart from increases in population (predicted, requiring more services), a modest increase in serving the natural catchment for those departments that don’t do that fully at present would help the finances while having a minimal impact on surrounding Trusts (who have natural increases in workload to cope with in any case).
You were right to question robustly the ludicrously low estimates of catchment (and one can only conclude that these were done to reinforce the opinion reached before the team arrived). My previous but one epistle has the proof (0.46% of the relevant work in the UK – this equates to a population of 275,000. Some departments do more than 0.5% (300,000 equivalent). If you believe that our catchment is 180,000 then we are bringing in a considerable amount of work from outside (I prefer the concept that our natural catchment is, in fact, somewhere around 275-300,000). Some services, if they were independent mini-Trusts are perfectly viable already or even contributing positively, as well as those recovering towards that.
Is a “big bang” a sensible way of proceeding?
Attending to the items that need attending to is the most efficient and parsimonious way of allowing services to be sustainably developed in the long term, including increase in community provision (fine as an aspiration, wholly unrealistic next week).
There are strong arguments, based on NHS experience over many years, in any locality for thoughtful and stepwise change but our recovery is important for the morale of the whole NHS and (if they could only see it) for any government in charge of it. We not only have to recover organisationally (accepted), clinically (quite feasible) and financially (not easy but possible, especially if the RELEVANT areas are attended to) – but be seen to recover and recover as an intact organisation (however much networking we chose to do with relevant partners (plural) in the clinical and non-clinical arena).
Are the Staff up-for-it?
I would strongly take the view that no hospital, staff or population has had to put up with this type of “spotlighting” and all the disadvantages of that – and that the NHS as a whole should seek to assist us while they all learn the lessons on quality recovery that will be available from us. If the Trust is given more time, the NHS may also be given the opportunity to learn how District Hospitals can become more clinically and financially viable. For the rest of the NHS this may be a less painful way to learn than having to learn for themselves – a sure way of wasting huge resources. If you think I am making a “special case” for Mid-Staffs which is almost political then you are right – and I think our MPs should argue that strongly. After all, the only real political objection to this would be that, actually, the DoH plan is to close most DGHs altogether (err …)
What about networking of services?
We already do that for many services. For example oncologists (cancer doctors) visit from Stoke and Wolverhampton and have done for some years. On a case by case basis this can be done in order of, as it were, priority alongside general measures to bring efficiency to the organisation without detriment to quality (possible with sufficient time, not if done in a hurry or with any large upheavals). Many departments, as mentioned, are “viable” on all counts as it is so there’s no merit in destabilising them though further workload and efficiencies may contribute to the Trust’s better position while maintaining a locally available service.
Why not just travel?
I would hope that the Government are mindful that the main problems the public see in the system are basic care and quality and access to those services (the poor and impoverished are less vocal but probably more needy on this front). We should perhaps learn from the most excellent – Team GB cycling are the best in the world because they are good at small, incremental improvements.
Is Stafford still a dangerous place?
As you have correctly blogged, it never was. Poor care yes (still happening in the NHS where nursing staff are overstretched. For the past 2-3 years even the official figures have put Mid Staffs high up the “league” – (Dr Foster) SHMI reports for the 12 month period April 11 to March 12. Charts show that MSFT’s crude mortality rate is better than the national average for both elective and non-elective activity (2.96% compared to 3.15%). The non-elective percentage of 3.29% is statistically significant i.e. unlikely to be simple variation.
These improvements in major services for local people have taken very considerable time and effort – any distraction, especially a major structural change would be detrimental to patients as well as a kick in the teeth for the staff (don’t underestimate the loyalty shown here – almost everyone who has stayed – and that’s the vast majority, including some staff in shortage specialities and roles, would have been very much more comfortable for the same salary by working somewhere else in the last 5 years) – bear in mind also that they and their patients have had to manage all this against a background of yearly higher management changes in the Trust, NHS structural change and host purchasing/commissioning funding at the lower end – I would invite you to go to the PCT public websites and take the declared budget for our PCT (South Staffs) and divide it by it’s declared population then do the same for Stoke and then also NorthStaffs/Moorlands. You will discover that the differences would allow us to build and open another (albeit unnecessary) hospital Trust while continuing to run the current one and still have money left over – i.e. the concept that we REALLY have a financial problem may not be entirely accurate (through we are doing quite well in dealing with the one we are told we have).
What about the regulators?
There has been a huge burden of regulatory visits (all of whose members had no duty to assist, only to report). It is said that at one point, Mid Staffs had more regulators on site in a fortnight than most Trusts have in a year! Sir Stephen Moss, retired chairman, in his summing up to the inquiry said that the main thing he took from his experience was that regulators/inspectors should not be allowed to just visit and criticise but have a duty if they do criticise to then help and assist.
Nonetheless, advances have also been made through this period. A good example is R&D. Clinical Trial entry, I believe has Mid Staffs in the top 8 in the UK for DGHs. This is not only laudable in itself (and in accord with Government policy) but contributes to good clinical care of patients).
Is Mid Staffs a test case?
This is important, more so for the poor, impoverished and disadvantaged, for whom the NHS was really created. The problem with many “consultations”/reports in the NHS is not only that they are often a foregone conclusion but they are conducted by the upper middle classes amongst themselves (Bureaucrats, Senior managers, Commisioners, Doctors ….). I am not making a “class-war” point here, merely pointing out that these individuals are at risk of not REALLY appreciating what the majority of people consider important, especially in terms of access to services. There is evidence from the 50’s and 60’s that before well functioning DGHs were widely available, the less well off simply didn’t access what was, in theory, available because it was too far away (e.g. a study of access to Cancer services at the Christie in Manchester, by people in Blackpool before they were available in Blackpool).
If the NHS as a whole is going to benefit/learn lessons from our very considerable discomfort over some years, then the least the NHS can do for us is to leave us with decent, locally organised provision. The best news for staff and patient morale and recruitment/retention would be an announcement that the Trust is going to be allowed, nay assisted to continue it’s own recovery as an entity, if for no other reason than to show it can be done and how that might be achieved.
It is my view, from long service in the NHS AND experience as a patient that what has produced civilised Health Care in the UK was, of course, the setting up of the NHS (people who remember what was before that are pretty clear about this) but also, and equally importantly, the advent of the DGH – bringing care for the most sick and disabled to their locality. This fight is, therefore, well worth fighting and I am glad that you are keeping a very close eye on what is happening.
The idea is bandied about only University Hospitals can provide safe care, hence DGHs should/would go. After all the hard work on this front at Mid Staffs (and many other DGHs) this should be refuted on the following grounds 1) If all the hospitals in the West Midlands were closed beginning with the highest mortality and working down (as an overall indicator of safety) then we would be the last to close and 2) Despite many advantages (particularly funding) the University hospitals are not immune to errors and bad practice and have been the location of some of the NHSs most disastrous errors (furthermore many of our patients who have to go for some of their care elsewhere do not universally praise it). Don’t get me wrong, we have general confidence in our referral centres (otherwise we wouldn’t refer there) but they aren’t perfect and we help them (shared care, timely information …) as much as we can. 3) Good care is clearly possible on a local basis for many services – and is disproportionately important for the majority of “ordinary” people.
Final thought before my brain melts:
In a civilised society, to effectively close down acute care for a population of 300,000 spread over 325 sq miles that is currently being provided to a high standard for the sake of, at most, some marginal and possibly temporary service configuration and financial issues would be, would it not, an obscenity?
Indeed it would! Lots to digest here, but really useful – many thanks!
You’re welcome. Many Staffordians are (once they get over the shock of what your analysis implies) very grateful for your efforts. After years of kickings of one sort or another, a bit of compassionate understanding and vision is a welcome relief, however temporary.
You’re very welcome. Knowing the facts as I now do, I consider what has been done to Stafford (both the hospital and the town) obscene, and I’m glad to be able to do a little bit to shed a truer light on it.
Just wondering if you’d noticed the connection between Lewisham and Stafford? Lewisham has acute services (potentially) removed in favour of a neighbouring Trust that needs money to pay for PFI scheme. Stafford has (potentially) acute services removed. These patients will now travel to either Wolverhampton (an amount of PFI), Walsall (big PFI) or Stoke (massive PFI). To put it another way, the re-payment of an indecent amount of money to PFI shareholders takes priority over sensible healthcare decisions to the extent that if you haven’t got a PFI scheme to pay off, all your acute services are sacrificed to your (albeit somewhat distant) neighbours.
Do her majesty’s opposition realise what a gift is being handed to them here? They should take the content of your recent blogs, load it into a baseball bat and continually beat Mr Hunt and Cameron over the head with it. Both local MPs are conservative so although they are fighting a rearguard action (which could, conceivably bear fruit), the more vociferous part of this argument will have to be at a national level. May I suggest that Mr Milliband says that the next (One Nation) Labour government will not only reverse the Heath Reforms but also reverse any draconian removal of acute services imposed on random areas of the UK. Thankyou.
Yes, I’ve commented on it in a couple of posts – but it’s worth a specific one to draw the parallels together.
I’m getting random thoughts now but
1) can you imagine the impact on the staff of this on-going uncertainty (and they’ve had a lot to cope with for quite a long time). Can’t decide whether to jump ship now, however disruptive to themselves or the service or stay, do a job they’re proud of for their local community and hope sense will prevail. Of course, it’s an old management trick to create such havoc that you can’t recruit or retain staff then say “well cor blimey, we can’t get the staff, it’ll have to close!” Imagine the irony – people from Stafford travel to work in Stoke (or Wolverhampton, Walsall etc) in order to treat people from Stafford! How is that good for care or indeed economics?
2) clearly the tariff system and work rotas/specialisation has been designed to make “viability” (of various sorts) an issue – following which policy dictates “solutions” that would be impossible to implement as a matter of policy (e.g. vote for us, we intend to close 50 local acute hospitals!) – all of these issues are easier to deal with if you have a larger set up. In any civilised society you would determine what is feasible to do in any given size/geography and pay accordingly. You would accept that tiny rural populations will need a heavier “subsidy” (or risk-share as I would prefer to annotate it) than medium-sized semi-rural, denser populations, who will need a bit more help than a convenient urban population of 600,000 living in reasonable proximity (which happens to be a very convenient fit for secondary care provision). Surely the current way of proceeding, given all the extra travel for these disadvantaged populations and their relatives is simply a tax on location (and a disproportionate, hence regressive, tax on the poor).
I’m getting annoyed now so I’m going to sign off.
I know just what you mean. Have you seen my CCGWatch idea? While it’s aimed at CCGs, galvanising people to resist Monitor’s unwarranted changes would fit perfectly well with its aims as well – and should be just as strongly underpinned by the NHS constitution.
If you agree, perhaps you know how I can get the message circulated around the hospitals and the local area? If I can get enough funds together to cover at least the first couple of months, MSFT could be the first live project and we can try to force local staff and public into the decision-making process – as they have a legal right to be!
No I haven’t seen it …………. I have now. This is, of course, an excellent idea. No doubt you would find allies and expertise in the NHS Federation, KONP and the NHS Consultants Association amongst others. I will donate when I’ve finished here. To get your message through to the hospital staff, there must be union reps (UNITE, BMA, RCN) in the hospital and there must be a consultants committee not part of the management structure (with a chair, secretary etc) – the switchboard might give you the e-mail addresses or the public website may give some info. Local people – local labour and lib dem parties (and why not conservatives!) must have machinery for dissemination. I imagine the cost of a full page Ad in the Express and Star (Stafford edition) can’t be more than £125 a throw (you may be interested to know that neighbouring Trusts (Wolverhampton, Dudley) have advertised to the public that way!). The usual social media (no expertise, I don’t use them) would also apply if you can start something off. There are 2 local save the hospital groups set up in the last year or two (Save Stafford Hospital and another, seemingly separate one) – one has a person called Diana Smith on it who is very active in the local paper correspondence columns and extremely knowledgeable (an A** contact I would think). Both MPs have open access hospital groups running for a few months ………
Thanks for the ideas and the willingness to donate! I know Diana, and I’ve been trying various things via Twitter etc. It’s a slow process to get started, but ideally I’d like to be up and running in time for the CCG launch in April.
1) An analogy. An individual patient has kidney failure. A donor is allowed to take a risk of possible damage to themselves and donate one kidney. It is considered wholly unethical to take two kidneys under any circumstances. A local hospital has a number of rota and financial problems and so do those surrounding. It might be considered ethical to make careful adjustments to some services to keep the neighbours alive and well, especially in complicated specialities that you can’t do everywhere (low volumes, lots of expensive equipment etc) while maintaining reasonable health locally. Is it ethical to destroy all local acute services to improve those surrounding? Has ethics a place in these matters?
2) A suggestion for PMQs.
Mr Milliband “The PM has direct experience of good NHS care both local and specialised – indeed has cited this as a reason why the NHS is “safe in his hands” – why then is he intent on closing all acute services (ie services for ill patients) at Lewisham, Stafford and no doubt in up to another 50 rural and semi-rural areas”
PM “Financial issues, Role of Monitor, Royal Colleges, shortage of nurses, blah, blah, blah”
Mr Milliband “The PM has an extraordinarily short memory. Robert Francis, in his recent report, emphasised that driving the NHS primarily according to finances is what did lead and will lead to poor care (and is probably more expensive in the end). He said what is needed is a change of culture. Perhaps a deep self-examination and change of culture should start with the government!”
🙂 and 🙁 !!