I’m still working my way through Monitor‘s report on its reasons for putting Mid Staffs Foundation Trust (MSFT) into administration, and will write on that shortly.
But what’s already clear is that the decision to call in administrators, with the likely result of reducing Stafford hospital to not much more than an out-patients centre, is completely against the wishes of local people – and local clinicians, even though Monitor claims it has consulted with both.
This bodes ill for the wider NHS, as 14 other Trusts have been singled out for ‘special treatment’ on the spurious basis of a supposed similarity in ‘Hospital Standardised Mortality Ratios’ (HSMRs) – a statistical measure that is based on massively erratic and uncontrolled input of ‘mortality codes’, and is therefore useless as a measure of hospital quality.
But it bodes even iller in the short term for the people of Stafford, who face losing their local, and much-improved hospital and having to travel considerable distances for even emergency treatment. Even a local Tory MP is outraged by the decision.
As I said, I’ll write a fuller analysis of the decision shortly, but very briefly, just a few of the reasons why Stafford is supposedly unsustainable are:
- It doesn’t serve enough people to be viable – even though Mid Staffs NHS serves 29% more people than the neighbouring North Staffs Trust
- The Mid Staffs ‘brand’ is toxic – even though the Trust overwhelmingly has the support of local people
- The Trust ‘had to be given significant financial support from the Department of Health last year in order to maintain provision of services for patients. These circumstances cannot go on indefinitely” – even though both the Dept of Health and Monitor agreed a financial plan with the Trust in January 2012 that was to last until 2015, which is not anything like ‘indefinitely’, and 2013 is far too early, according to the terms of that agreement, to put the Trust into administration.
As far as MSFT’s clinical and financial performance are concerned, the report by Ernst & Young, who were called in by Monitor, acknowledges that
The Trust has made significant progress in establishing its operational sustainability by implementing both strategic and tactical change over the past 18 to 24 months
and
MSFT has been working closely with Monitor to improve its performance in recent years, and has made significant improvements in the clinical care provided for patients. The Care Quality Commission (CQC), the quality regulator, has said it no
longer had outstanding concerns about the care delivered by MSFT.
So, both in clinical and financial terms, MSFT was on track – so why let Monitor loose and allow it to call in the administrators to implement plans that will rob the people of Stafford of their hospital?
Well, a local NHS worker reminded me of something I’d forgotten: in 1997, a young David Cameron stood as the Tory candidate for Stafford in the General Election – and lost humiliatingly. Stafford had been a relatively safe Tory seat, with a majority in the 1992 General Election of almost 11,000 – which Mr Cameron turned into a defeat to Labour candidate David Kidney by 4,314 votes.
I’m told that Mr Cameron turned up for the announcement of the polling result in confident mood – but by 3am was to be seen disconsolate in a corner, desolated by his humiliating defeat.
David Cameron has ridden through life and politics on a wave of privilege and connection. From a privileged childhood with family connections to royalty and aristocracy, to his only ever job outside politics (in PR for TV company Carlton), which he was given at a salary of £90,000 pounds by a friend of his mother’s at her request (no wonder he’s on the side of the strivers!), to his first position at Conservative Central Office, which came on the back of a mysterious phone-call from Buckingham Palace – Cameron has never been thwarted in anything he wanted.
Except by the people of Stafford in 1997.
Has Monitor been let off the leash because Cameron still smarts from his humiliation? Is the decision to strip a County Town of its much-needed and now strongly-performing hospital in spite of clinical and financial progress a form of ‘payback’ by a vengeful Prime Minister still as livid as a thwarted toddler that the townspeople dared to reject him and delay his ambitions?
It would hardly be out of character for a man of whom even the right wing press who had worked with him when he was at Carlton said
a poisonous, slippery individual (Ian King, former business editor of The Sun)
and
I wouldn’t trust him with my daughter’s pocket money (Jeff Randall, Daily Telegraph)
Consider the facts for yourself. But I think it’s beyond question that Cameron will hold no affection for the one place that hasn’t given him the power and position he considers his due. Even failure to win a majority in 2010 didn’t prevent him taking up residence at Number 10.
It’s speculative at this point, of course – but the particularly brutal and baseless nature of the opportunistic assault on Stafford hospital would sit perfectly with the possibility.
Stafford made him wait 4 years for a seat in Parliament. It’s hard to see him letting that ‘slide’ unpunished.
Very interesting blog. You may have the figures wrong in the catchments at the beginning of this piece. North Staffs Hospital (UHNS) has a geographical catchment containing 450,000 and does some specialities for a wider area. MSFT has an equivalent figure of 300,000 as mentioned in previous contributions (and both figures add up if you look at relevant workloads to general services). I wonder if you’ve looked at the North Staffs and South Staffs PCTs (Burton does some of the work for them etc). PCT catchments are administrative, hospital catchment areas are people who live closest – often similar but not always (South Staffs PCT is one of the biggest).
North Staffs claims a population of 214,000 on its website, and Mid Staffs FT 274,500 on theirs, so I was going from those. It was North Staffs PCT website, but they lay claim to the UHNS hospital.
You may be confusing North Staffs/Morelands PCT and Stoke PCT. They are both served by North Staffs Hospital (UHNS) and together they come to my aforementioned 450,000. Nonetheless Mid Staffs is a substantial population within a substantial land area. It is of course the case that you can re-divide any part of the country up and attribute populations to different hospitals. The fact is that MSFT operates 2 sites that cover a geography – within which people live (is that, somehow their fault?) and the figures suggest that most of them use the Trust’s services when they are very ill (critical care) and ill (acute care) as well as when they are mildly unwell (some will have serious conditions) and well (ditto) (outpatients/day-cases). What reassures a local population is that help is at hand when they are very ill or ill – yet this is the care E&Y propose should be removed.
Forgot to mention that the Staffordshire General Infirmary (SGI, sited in the middle of Stafford) which closed when the Stafford Hospital site (on the outskirts) was completed in 1996 was the second oldest DGH in the country (Worcester was the first). So the concept that the County Town of Stafford needs an acute hospital is not a recent concept!
Or to put it another way, since the SGI was a Voluntary Hospital (public subscription, free at the point of use when ill), the current E&Y plan will put back access to acute care in Stafford and surrounds to where it was in 1765!