Spend £30m or save £53m? Insanity of Stafford closure plan

The goings-on at Mid Staffs NHS, and the events and statistics that led to them, have been a main theme of this blog for some weeks now. I’ve shown variously

• that the hospital’s mortality statistics in no way supported the ‘400-1200 avoidable deaths’ claim and how this claim has been used by government and media to attack not just Stafford hospital but the wider NHS
• that the hospital’s mortality statistics were significantly below the national average, once the problems with coding input had been corrected
• that Stafford should be used by Health Secretary Jeremy Hunt as a blueprint for addressing issues in the NHS – but as a model of how to turn a hospital around, not a means of closing other hospitals as he has announced he will do,

I’ve also shown that Monitor’s move to put Stafford hospital into administration can only be politically motivated (and part of Hunt’s plan of attack on the NHS).

The hospital has been struggling financially – largely as a result of being underpaid for the treatment it was giving because of the same coding problems that caused the false mortality alerts – but as recently as the beginning of last year, the Mid Staffs board agreed a recovery plan with both Monitor and the Dept of Health (DH) that was to run until 2015.

For this plan – to which Mid Staffs had adhered – to be scrapped after just one year of the four it was to run by the very same bodies which had approved it, just days after the publication of the Francis report, demonstrates a level of cynical political opportunism that a child could spot.

But the Tories don’t worry about subtlety when they have an opportunity to close a hospital – let alone when they intend to use it as a pattern and excuse for closing 10% of England’s acute hospitals.

Even so, some unsubtleties are so blatant that they make your mouth hang open that even the Tories will try them.

According to Monitor’s ‘worst case’ analysis in January, Mid Staffs’ needs to save some £53m over the next 5 years. The recovery plan – agreed by both Monitor and the DH, remember – was to address this issue. The fact that Stafford’s ‘Payment by Results’ (PBR) coding is now exemplary would have gone a long way to addressing this, by increasing the Trust’s income to the appropriate level for the treatments it provides.

All of a sudden’ this sum – over 5 years – is unaffordable, and the only solution is to break Stafford up and downgrade the remnants until the people of Stafford are effectively without a local hospital that has been there for generations.

Yet – as part of the very same break-up plan – the government is going to have to give the neighbouring University Hospital of North Staffordshire (UNHS) in Stoke at least £30m right now to enable it to cope with the influx of patients it will receive if the administrators’ break-up of Stafford goes ahead.

Here’s an example of why:

The maternity unit in Stoke is already regularly closed to new patients because it is full – patients who are on the ‘roller coaster’ of giving birth, and who don’t have the option of waiting until a more convenient time. These mothers and arriving babies have to be taken to neighbouring hospitals in order to receive the care they need.

Including Stafford hospital – which has never closed the doors of its maternity unit.

Yet now, under Monitor’s and its administrators’ plan, the never-closed unit at Stafford is going to vanish – and the slack is supposed to be taken up in Stoke, with an extra 700 imminent mothers a year using its services. So UHNS is going to need a massive extension and up-staffing of its maternity unit if it’s to have a prayer of handling the additional demand generated by the closure of Stafford’s very capable unit.

A £30m injection of cash into Stafford hospital would put the hospital on a solid financial footing to match its now-exemplary clinical performance and reduce its £53m savings target over the next 5 years to a much less daunting £23m (or probably much less, since the hospital’s PBR income has improved).

And even if the government didn’t provide the cash-injection to Stafford, it still makes more sense to keep Stafford open. Consider the options:

Option 1: spend £30m now in order to deprive a town of its hospital
Option 2: save £53m over 5 years in order to keep a hospital that serves around 300,000 people and which has been adjudged by the Care Quality Commission (CQC) as ‘meeting all the essential standards of quality and safety‘.

Even without considering all the other impacts on the people of Stafford of the closure of their hospital, this would surely merit a place in any dictionary as a perfect example of a ‘no-brainer’.

Unless, of course, you have an ulterior motive: a lust not just to close one hospital but to use the methodology to close at least 14 others, that is.

Wouldn’t you agree, Mr Hunt?