AN EMERGENCY summit at Stafford Hospital saw plans approved to pause elective surgery and close Cannock's Littleton ward temporarily in order to deal with a staffing crisis that has worsened as prolonged uncertainty continued around the trust's future.
Administrators at Mid Staffordshire NHS Foundation Trust approved the plans drawn up by the executive team to tackle the growing issue around staffing caused by ongoing recruitment and retention problems, the resignation or several key members of nursing staff and the annual increase in activity anticipated during the winter period.
Chief executive Maggie Oldham said: "This period of uncertainty about the future of the Mid Staffs has begun to have a bigger impact on our ability to recruit and retain staff.
"Since our winter plan was approved by the TSA in November, our staffing situation has worsened," she said. "We have been working not only with our own staff but also together with our commissioners and colleagues from neighbouring trusts to find solutions to this challenge.
"Despite all the work that has been done over the past few months to try to improve the situation, we have not been able to recruit enough staff to care for the additional patients we had been planning to accommodate over the winter."
Mrs Oldham said, specifically the trust had been unable to recruit sufficient registered nursing staff and has also lost several senior nurses meaning the trust had a shortage of experienced staff and was becoming increasingly reliant on bank and agency staff.
"While we have been able to recruit locum doctors to fill vacancies, we recognise that the contribution of many locums may not be equivalent to that of our permanent doctors, as they are not as familiar with our hospitals and our policies and practices," she said. "Our senior clinicians and managers have been working on what could be the appropriate safe options for us to implement in January so that we maintain safe staff-to-bed ratios in line with professional guidelines."
Mrs Oldham outlined four measures, to pause elective surgery requiring an inpatient stay at both Stafford and Cannock throughout January to free up nurses to support wards at Stafford, to close Littleton ward and repatriate the staff there to Stafford, to support the implementation of schemes by Stafford and Surrounds Clinical Commissioning Group (CCG) to reduce hospital admissions and to work with neighbouring trusts to find 12 experienced nurses to work at Mid Staffs over the winter.
She admitted if the measures outlined didn't work then a last resort would be to reduce the opening hours of the A&E by around two hours a day but stressed that option would only be discussed if the situation continued to deteriorate.
"I am desperately optimistic that we can prevent this from happening," she said. "I am very aware that if we were to initiate a further closure of A&E , not only would our patients have to travel further but our neighbouring trusts would have to step up to cope with the added demand.
"While this would be an option available to the trust to consider should our staffing situation deteriorate further, currently all our efforts at Mid Staffs, supported by our commissioners and neighbouring trusts, is to deliver on the other options so we can continue to provide local emergency access to patients."
Medical Director Paul Woodmansey said the Francis Report had noted insufficient nursing as one of the major causes of the failings at Mid Staffs.
"The problem we face now is insufficient nurse to staff the ward to a safe level," he said. "We're not going to allow similar problems to develop.
"We can't tolerate insufficient nurses and it has meant we have had to contemplate some schemes we would rather not have to contemplate.
"Our top priority is patient safety and patient care.
"Emerging now is a plan which gives us much more confidence that we can face the winter with sufficient nurses and continue to provide safe care to our patients."
Director of nursing Suzanne Banks said the staffing numbers were being reviewed on a daily basis.
"We are in a fragile situation," she said. "Staff are flagging up concerns and predicting where the situation with the workforce is going to be on a daily basis.
"This isnt about just filling numbers, this is about having a core workforce that are clear leaders and committed to the organisation."
She said thought the situation around recruitment and retention would improve now administrators had published their final report adding staff were already telling her they were more confident knowing the hospital did have a future.
Andrew Donald, chief officer of Stafford and Surrounds CCG said a number of schemes to alleviate pressure on the A&E were already being implemented.
Joint administrator Professor Hugo Mascie-Taylor approved the proposal, paying tribute to the executive team for producing an 'excellent evidence-based proposal' that was more than just 'a series of intuitions'.
Mrs Oldham closed the meeting with an appeal to the public urging them to only attend A&E when absolutely necessary.
"Please consider your attendance at A&E.," she said. "The clue is in the title.
"We would never put anyone off attending, but if someone can be treated by their GP or the 111 service I would encourage them to contact them before they put additional pressure on the hospital in what potentially could be a challenging time."