Recommendations for Mid Staffordshire NHS Foundation Trust: decision by Secretary of State for Health.
I wish to inform the House that I have made a decision regarding the action recommended by the Trust Special Administrators (TSAs) of Mid-Staffordshire NHS Foundation Trust (Mid Staffs, or the trust), as I am required to do by section 65KB of the National Health Service Act 2006 (the 2006 Act).
A document setting out in more detail the reasons for my decision is available in the Library.
Local people suffered too much for too long under a system which ignored appalling failures of care in their local hospital. They now deserve to know that same system has learned the lessons and is guaranteeing high-quality, safe services for local people. The proposals I am accepting today will provide just this.
The strength of public interest in the TSAs’ work, and the huge response to their consultation exercise, is a testimony to the great commitment local people have to the future of their hospitals.
I must also commend the trust’s staff, who have helped turn around the quality of care provided at Mid Staffs, and who in recent months have continued to provide quality services in the face of great uncertainty about the trust’s future. The interest, support and contributions of honourable members have also been extremely valuable. In particular, the way in which the Hon Member for Stafford has championed the interests of local people at every stage of the process has been remarkable. I believe the proposals I am accepting today will bring about improvements for local people that reflect his continued concern for patient welfare and the future of Stafford Hospital.
Today’s announcement secures a first-rate offer for local patients – something they were denied for too long. Great strides have been made towards improvement in recent years but the challenges remain stark. Without over £20m in subsidy funding from the Department of Health in 2012 and 2013, the trust would have been unable to pay its staff and suppliers. At the same time, a number of services are being operated with consultant numbers below Royal College guidelines, and the trust has experienced on-going challenges in recruiting and retaining staff. Patients deserve high quality services, which are clinically sustainable.
Today’s announcement provides an assurance that the solution to the Trusts’ financial and clinical problems will deliver safe and high quality services, now and into the future. I know that the TSAs and local stakeholders have worked hard to develop a set of recommendations which will achieve this.
Having considered the TSAs’ proposals in detail, I confirm I am satisfied on each of the points set out in section 65KB of the legislation, and therefore support the action recommended by the TSAs. I am also satisfied that, in accordance with my request, the TSAs have undertaken a thorough analysis and taken account appropriately of the issues regarding the four tests for reconfiguration. I am pleased that, after a long period of instability, we are able to offer the local population of Mid Staffordshire the certainty it so desperately needs.
Before turning to the detail of the proposals, I would like to remind the House of the background to the administration process at Mid Staffs. Monitor appointed an independent Contingency Planning Team (CPT) to the trust in October 2012. In January 2013, the CPT concluded in a report for Monitor that Mid Staffs was neither clinically nor financially sustainable in its current form. In a subsequent report the CPT advised that neither the Trust nor local commissioners would be able to deliver the changes required, and consequently recommended the appointment of administrators. On the basis of the CPT’s conclusions, Monitor appointed TSAs to Mid Staffs with effect from 16 April 2013. Since taking up their role, the TSAs have found no reason to dispute the CPT’s conclusions regarding the trust’s sustainability, and their analysis has only strengthened the case for change.
Since April the TSAs have been working with the trust, local commissioners and providers, and a wide range of other stakeholders, in order to develop a solution for the services at Mid Staffs. The TSAs’ final report, which has been approved by Monitor, was submitted to me on 16 January.
The TSAs’ report recommends that Mid-Staffordshire NHS Foundation Trust is dissolved, and that Stafford and Cannock Chase Hospitals are operated by other local providers. It is vital that this structural change is made as soon as possible to stabilise local health services. The TSAs have also proposed a clinical model for the services currently provided by the trust, which their independent Clinical Advisory Group (made up of leading clinicians from the Royal Colleges) has confirmed will be clinically safe. I am pleased that under this model the majority of patient visits, approximately 90%, will continue to take place at Stafford and Cannock hospitals. I also welcome the enhancements proposed for a number of current services, for example, the inclusion of specialist frail and elderly support within the Medical Assessment Unit at Stafford. All of this will contribute to a much improved offer for local people.
However, to ensure this improved offer, it is clearly not possible for all of Mid Staffs’ services to go on as they are, and therefore the TSAs’ recommendations will mean moving a small minority of services away from Stafford hospital. Local people can be reassured that local commissioners would need to be satisfied that there is sufficient capacity available elsewhere before moving services. In parallel, I am asking NHS England to identify whether consultant-led obstetrics could be sustained at Mid Staffs in a safe way in the future. In doing this, NHS England will work with local commissioners as part of their wider review of the local health economy.
The TSAs’ report also identifies the funding required to support this model and I am satisfied that, in light of intervention from the NHS Commissioning Board (also known as NHS England) in the form of time limited funding, and a commitment from commissioners to deliver further savings during and following implementation, the recommended clinical model is affordable in the medium term and, subject to the actions of local commissioners, can be a financially sustainable one. My Rt. Hon friend the Chief Secretary to the Treasury has expressed his support for my acceptance of the proposals.
On this basis I am content for the proposals to proceed to implementation. I would like to emphasise the critical role commissioners have in this process, and in particular their commissioning freedom to build upon the TSAs’ recommendations, such as in maternity, where they consider this is to be sustainable and in the interests of patients. Local commissioners will also oversee and monitor local service changes as part of their on-going commissioning responsibilities, including, where going beyond the recommendations, undertaking further public engagement where appropriate.
I therefore ask that local commissioners, local providers and all other local organisations work together during the coming months and years to implement the proposed changes, with appropriate involvement from NHS England and other national bodies, in order to secure the high quality services that the people of Mid Staffordshire deserve.