Analysis: Mid Staffs administrators' plans would see millions in investment

Trust special administrators Hugo Mascie-Taylor, a former medical director, and Ernst and Young consultant Alan Bloom last month published draft proposals that would see the troubled foundation trust dissolved.

In a detailed interview with HSJ, they explained how their plans would see investment, provided directly by the Department of Health, going towards the capital costs of creating new services and additional capacity, and covering the current deficit in running Mid Staffordshire’s services.

Under the plans, its services would be divided between the University Hospital of North Staffordshire (UHNS) to the north of Stafford and The Royal Wolverhampton Hospitals Trust to the south.

Key proposals include UHNS taking over Stafford Hospital, which would retain an accident and emergency department, opening between 8am and 10pm, along with a reduced critical care unit. It would no longer have a maternity unit, emergency surgery or inpatient paediatric services.

Cannock Hospital would be taken over by The Royal Wolverhampton Hospitals Trust.

The administrators said 91 per cent of patient interactions at Stafford and Cannock hospitals would remain in the area under the plan.

Professor Mascie-Taylor, speaking to HSJ, reiterated Mid Staffordshire Foundation Trust was neither clinically nor financially viable in the long term.

He said the solutions the administrators had proposed meant the majority of care “currently provided in Stafford would continue to be there”.

“The changes we have proposed have been based almost entirely on clinical advice,” said Professor Mascie-Taylor.

“The only exception is maternity led units, which are safe, but the reason we have not proposed one is we still have an £8m gap to close and no provider is prepared to deliver it - and no commissioner wants to commission it.”

Fellow administrator Alan Bloom said: “We are trying to get to a solution, a service that is clinically and financially sustainable from three years out for up to 10 years. It is not about what [the trust] are doing today.

“We are very well aware that the two providers who have helped us develop these proposals have got their own issues. The point is the proposals we are recommending are for a period of time after a significant transition phase.”

Mr Bloom said the transition − the transfer of services and dissolution of Mid Staffordshire - would take between two and three years, but could be shorter for some activity if neighbouring providers were ready sooner.

“There is no point keeping Mid Staffs alive longer than it needs to be,” he said.

The exact sums likely to be invested in the trusts if the recommendations are implemented are subject to debate and varying estimates.

However, the administrators estimate the cost of implementing their recommendations to be £305.4m, covering costs of transition and capital spending at Mid Staffordshire, UHNS and Wolverhampton.

They estimate the cost of transition at £108.4m over three years, including £77m as on-going subsidy to cover the financial deficit at Mid Staffordshire.

They expect around £197m will be needed in capital funding. That includes around £97m at Mid Staffordshire and between £50m and £70m at UHNS.

North Staffordshire has faced significant financial problems in the past year and is predicting a £31m deficit for 2013-14.

Speaking to HSJ, UHNS chief executive Mark Hackett accepted the proposals were “a big challenge”.

He said: “We need to develop a new direction and strategy for [UHNS] given that it is in severe financial difficulty.” Mr Hackett added that his trust’s proposed link with Mid Staffordshire would “not be part of” UHNS’ own efforts to save money.

He said around 25,000 patient attendances − mainly elective − at UHNS could relocate to Stafford.

However, in relation to service transferring from Stafford to UHNS, Mr Hackett said: “We will require £70m of capital investment at the UHNS site in order to accommodate the transfer of particular activities such as surgical work, paediatric work and, to a lesser degree, the maternity department.

“At the moment we have services at Stafford that are being delivered on a scale that is too small along with the type of clinical cover and volume of work needed.”

Mr Hackett, who joined UHNS earlier this year, said no activity would shift until services were ready.

He accepted there was significant public opposition to the changes but told HSJ: “We have got to listen to the public, but equally the public has to listen to the argument and the complete clinical case.

“We have to grasp this opportunity to deliver high quality services the public deserves and have the courage of our convictions, as well as the compelling clinical logic.”

The Royal Wolverhampton Hospitals Trust, which will take control of Cannock Hospital, has suggested an investment of around £59m would be needed to fund an increased capacity in its own maternity services and a rebuild of its accident and emergency department.

Elective surgery would move to Cannock Hospital from Wolverhampton’s New Cross Hospital.

Walsall Healthcare Trust has said £6m would be needed to extend maternity services at its Walsall Manor Hospital, to deal with extra births.

The proposals would also require an additional £1.2m funding to West Midlands Ambulance Service, for transferring patients from Stafford to neighbouring sites.

The draft report and the administrators’ proposals are the subject of a public consultation until 1 October. Health secretary Jeremy Hunt will make a final decision on them by the end of this year.