Stafford set to retain key services

Key maternity and paediatric services look set to stay at Stafford Hospital following a high-profile public campaign, according to a final report on its future.

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Support Stafford Hospital members before the publication of TSA's final report about future of services at the Mid Staffordshire NHS Foundation Trust

Key maternity and paediatric services look set to stay at Stafford Hospital following a high-profile public campaign, according to a final report on its future.

Trust Special Administrators (TSAs) appointed earlier this year to look at the long-term future of the scandal-hit Mid Staffordshire NHS Foundation Trust published their final recommendations, including several large changes to their draft proposals published earlier this year.

Under these proposals, a midwife-led maternity unit will be set up at Stafford, while there will be an upgraded 14-hour-a-day paediatric assessment unit staffed by specially trained clinicians - although seriously ill youngsters will still go to specialist centres.

The administrators also made it clear that basic critical care services will remain at Stafford, with very sick patients taken to other neighbouring hospitals.

The TSA had previously said the site would keep its limited-hours accident and emergency department.

At the trust's Cannock Chase Hospital, there will be more "step-down" care - where recovering patients are transferred from specialist hospitals to wards nearer their homes - and more elective surgery.

Meanwhile, it is still recommended to dissolve the Mid Staffs trust with the hospitals taken over by neighbouring NHS trusts.

A huge public campaign, which saw more than 50,000 march through the streets of Stafford earlier this year, had urged the administrators to keep maternity and paediatric services in the town.

Alan Bloom, one of the TSAs, said: "We now have a plan for the future which means over 90% of the people who currently use these hospitals continuing to do so."

He said the trust was "financially and clinically unviable" but the proposals were "the best chance" to ensure the long-term future of services.

Mr Bloom said that by doing nothing the trust's current £20 million deficit could have almost doubled in four years' time but under their recommendations it would fall to below £15 million over the same period.

The TSAs believe their plans will save about £25 million per year to 2017, while there will be £130 of capital funding to extend services at separate hospitals in Stoke, Wolverhampton and Walsall, run by University Hospital of North Staffordshire NHS Trust (UHNS) and The Royal Wolverhampton Hospitals NHS Trust.

Under the proposals, Stafford would be run by UHNS, and Cannock taken on by the Royal Wolverhampton.

About £40 million of the capital investment is needed to carry out much-needed maintenance and improvement of both Cannock and Stafford Hospitals.

The proposals require the agreement of independent health watchdog Monitor, which appointed the TSAs in April, and the final approval of the Health Secretary by February 26 2014.

Any transition would happen over three years, with the new structure fully up and running by the start of 2017 financial year.

Under the new arrangement, staff would be transferred to the two other trusts, with the process beginning as soon as the recommendations get Government approval.

Professor Hugo Mascie-Taylor, one of the TSAs, said: "I think, when we started this process, many believed our recommendations would be to close these hospitals but we have been able to preserve both Stafford and Cannock, and that must be regarded as a success."

Campaign group Support Stafford Hospital (SSH) was critical of the new recommendations, with chairman Sue Hawkins saying she thought the midwife-led unit - which will have no specialist consultants on the wards - would "dwindle away" because it would not attract enough women to sustain it for more than a few years.

"We're not happy," she said.

"It sounds good - they're saying 50% of people could deliver here but the reality is about 10% would choose to - people would choose to go elsewhere.

"We wanted in-patient paediatrics, but we haven't been listened to.

"An assessment unit for 14 hours a day in A&E, no provision for in-patient beds and it's not paediatricians running it."

She said the recommendations on critical care also "sounded like a bit of a fudge".

"What next? We have to wait for the Secretary of State, although I don't think it's going to change," said Ms Hawkins.

"Then we have to look to what we can do to influence the commissioners because that's really where the power does lie.

"It's not the end of the journey."

Mr Bloom said that, although the TSAs had now published plans for the long-term, there were immediate concerns over short-term staffing - particularly in nursing posts - and they were working with other health trusts and commissioners to tackle the issue.

"We will continue to run Mid Staffs until the trust is dissolved," he said.

"We've been working very closely with local providers and commissioners in order to deal with these (staffing) issues.

"They are particularly complex at Mid Staffs.

"We anticipate various winter-type measures which will need to be taken over the coming days and weeks, and any such action will be in full consultation with the commissioners and providers and will not undermine the longer term work we have done."

Although not in the TSAs' remit, Mr Bloom and fellow administrator Prof Mascie-Taylor expressed the view that the name of Stafford Hospital should be changed because of its negative associations with the basic healthcare failings identified through the Francis Inquiry.

The administrators were appointed after the Mid Staffs scandal and the subsequent inquiry which reported its findings in January this year and led to one of the biggest shake-ups in the health service's 65 years.

The inquiry, chaired by Robert Francis QC, concluded there had been basic failings in standards of care, with some patients left lying in their own faeces, given the wrong medication and others so thirsty they drank the water from flower vases.

It had followed a 2009 Healthcare Commission inquiry, which found that hundreds more people had died at Stafford Hospital between 2005 and 2008 than would ordinarily have been expected.

In the Francis Inquiry's final report, 290 recommendations were put forward to the Government on how to improve care in English hospitals and avoid another scandal like Mid Staffs.

In its response in November, the Government accepted 281 out of 290 recommendations, including 57 in principle and 20 in part.

Among those changes adopted were that from April 2014 all hospitals will have to publish monthly data showing staffing levels on wards, to aid transparency.

The Government stopped short of imposing a duty of candour on individual doctors and nurses to be more open and honest with families about errors and problems with their relatives' care, as recommended in the Francis report, instead placing the duty on organisations as a whole.

It also strengthened the duty of candour applied to individuals through clinicians' own professional bodies to encourage such behaviour as best practice among their membership.

Following the publication of the TSAs' report, Graham Urwin, area director for NHS England in Shropshire and Staffordshire, said: "Today the trust special administrators for Mid Staffordshire NHS Foundation Trust submitted their recommendations to the Secretary of State for Health.

"We fully recognise and acknowledge that the process so far has been challenging for everyone involved.

"NHS England supports the important first steps that the TSAs have proposed in their report and feel that this is a sustainable and robust clinical model, that will ensure safe and high-quality services will be provided for the people of Stafford and Cannock.

"NHS England looks forward to working with the TSA, clinical commissioning groups (CCGs) and other partners, as we take action and build a health economy in Staffordshire that is fit for the future."

The Royal College of Midwives (RCM) welcomed the TSAs' inclusion of a new recommendation for a midwife-led maternity unit at Stafford in its final report.

In a statement, RCM chief executive Cathy Warwick said: "The RCM welcomes the TSAs' report into the future of Mid Staffs.

"We are particularly pleased to see that the special administrators have decided to provide a midwife-led unit at Stafford Hospital, which will ensure greater choice of maternity care options for mothers and families and be managed in a maternity network with other providers."

She added: "We are committed to engaging with our members and stakeholders to help influence and shape the future provision of maternity services in this area to ensure safe, high-quality care for mothers, babies and families."

Andy Burnham, Labour shadow Health Secretary, said the proposals were a "downgrade" of services at Stafford and "a kick in the teeth" for the town's campaigners who have battled to keep major services at the site.

Mr Burnham, who was Secretary of State at the time of the Healthcare Commission's 2009 investigation into Stafford, said: "This was precisely the outcome I wanted to guard against when I commissioned an inquiry but stopped short of a lengthy public inquiry.

"I feared it would put the future of Stafford Hospital at risk.

"While I don't disagree with decision to call a public inquiry, the Government should have recognised the extra risks to Stafford and put in more support to help it through the uncertainty.

"Their failure to do so has resulted in the downgrading to a part-time A&E unit, removal of acute surgical care, the replacement of maternity services with a midwife-led unit and paediatric services being moved further away.

"Local people had a right to expect that the end result of the two inquiries would be to give them a hospital which is both safe and sustainable.

"This outcome will only fuel concerns that the Tory-led Government is taking the NHS backwards."

A Department of Health spokesperson said: "The patients of Mid Staffordshire deserve high quality services and the administration process has focused on making sure that happens.

"Monitor is now considering the proposals and we expect to receive them formally early in the new year."