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The excellent statement this morning by my right hon. Friend the Secretary of State for Health on the Government’s response to the Francis report on the Mid Staffordshire NHS Foundation Trust shows just how important that inquiry has been and how the findings will help to change the NHS for the better for patients. I particularly welcome the emphasis on zero harm and quality of care, including the proposals for the training of nurses and for a chief inspector of hospitals.
The recent Care Quality Commission report on Stafford hospital was encouraging too—a hospital that failed so badly has now met the standards expected—and I thank the retiring chief executive Lynn Hill-Tout, staff, governors and board for all that they have done. Yet, just at the moment when the people of Stafford should be emerging from a decade or more of pain and uncertainty, we are faced with another huge challenge. The report to Monitor by the contingency planning team, published at the beginning of this month, recommended the removal of most emergency, acute, maternity and possibly even elective services from the Mid Staffordshire Trust which runs Stafford and Cannock hospitals.
This puzzles me. Emergency and acute admissions to hospitals in the west midlands are rising sharply and departments are at full stretch. Just last month—February—West Midlands ambulance service reported delays to its vehicles of more than 30 minutes on more than 1,000 occasions at the University Hospital of North Staffordshire. That is not a criticism of that hospital, just a reflection of demand. The proposal, however, is to remove a substantial amount of that capacity, which is already stretched: 300 acute beds at Stafford, in addition to the 250 that have already been lost at UHNS as a result of the new, smaller PFI hospital. In fact, at least 60 have had to be reopened at the old site, as demand is so great.
The reason given for this is, as always, that if we move care out of hospitals and into the community, the demand for emergency and acute admissions will fall. That is only half the truth. It will fall, but only from the much higher levels it would have reached. Moving care into the community will stop the need to provide much more extra emergency and acute capacity, but it will not allow for substantial reductions in that capacity. This is the flawed assumption under which NHS leaders seem to be working.
There is a squeeze on emergency and acute tariffs that started under the previous Government. I have raised this issue before and I will continue to do so, because unless it is addressed it will eventually result in dangerously low levels of emergency and acute cover in parts of the UK. It cannot be sensible for trusts that deal in elective work to pile up surpluses while many acute trusts, on which we all depend, struggle to cope with mounting deficits.
It would be nice to believe that all hospital admissions could be elective—that all work could be programmed to fit into an ordered day—but life is not like that, especially when we have large numbers of people living longer, which I welcome, and then becoming ill suddenly with acute, complex conditions. That is why I firmly believe, as do most of my constituents, that acute district general hospitals have an important role to play. Indeed, if they did not exist, we would probably decide to create them, precisely because they are the best place for the initial treatment of the elderly with complex, acute conditions, who could be close to home and to their loved ones.
We do of course need to learn the lesson of Mid Staffordshire and other places. Such district general hospitals are usually too small to sustain many of the specialist rotas that are needed, but the solution is not, as is proposed for Stafford, to cram all serious emergency and acute cases into already overstretched neighbours; it is to work closely with those neighbouring trusts—even become part of them—and thus enable clinicians to work across neighbouring sites. This solution has the merit of combining the benefits of scale with providing care close to patients.
I met Monitor two weeks ago, and I welcome the assurance I was given by the chief executive, Dr David Bennett, that the trust special administrator, shortly to be appointed, will consider options other than those recommended, which are wholly inadequate. Monitor has the chance to show how smaller, acute general hospitals can not only survive but prosper under the wing of a larger trust. If it does that, it will have done the NHS and our country a great service.