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MP urges Monitor to rise to Stafford challenge

By Staf Newsletter  |  Posted: December 21, 2012

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STAFFORD’S MP took some of the problems facing the town’s hospital to the Houses of Parliament during a debate on health yesterday.

Referring to a report published by the Royal College of Physicians (RCP) in September Mr Lefroy said it was increasingly clear hospitals were struggling to cope with the challenges of an ageing population and rising admission rates.

He said the report highlighted the consequences of failing to meet those challenges and refers to the history of Mid Staffordshire NHS Foundation Trust.

“When the [Mid Staffs Public Inquiry] reports next month, we will have the opportunity to consider its implications for the NHS,” he said. “Today I wish to concentrate on the Monitor review of my trust in the light of the continuing rise in pressure on acute services that the Royal College of Physicians highlights.”

Mr Lefroy said there were three common themes he regularly heard in regards to issues in the NHS

“The first is that we need to do much more in the community and at home and much less in acute hospitals, and that we must therefore close acute hospital beds and use the money in the community,” said Mr Lefroy. “Although I agree with the premise, I dispute the conclusion.

“Community care is essential, but it must work before it results in a reduction in admissions and lengths of stay.”

He said the fact admissions were rising and according to the RCP, the fall in length of stay had ‘flatlined’ over the last three years, even rising for patients over 85, indicated the shift to the community either was not happening fast enough or indeed would not happen as expected.

“The conclusion also seems to ignore demography,” he said. “In the area served by the Mid Staffordshire trust, the population is expected to rise by some 10 per cent in the coming 23 years.

“The number of people over 60 will rise by nearly half, and the number of those 75 and older, those most likely to need acute services, will double.

“I suspect that is the situation in many parts of the country.”

Mr Lefroy said rising admissions, rising and ageing populations and flatlining lengths of stay all indicated an increased demand for acute services in the next 20 years.

“Yet the talk is, and has been for many years, of further reductions in acute beds,” he said. “It makes little sense to do that until community services and other medical advances mean that those beds are proved to be no longer necessary.

“In Stafford, there is a shortage of step-down beds, so rather than closing acute beds altogether why not keep them as community beds on the same site, leaving the door open for increasing acute services in the future, if and when the need arises?”

Mr Lefroy said the second theme he heard often was the need to integrate primary and secondary care more closely but said sometimes actions seemed to have the opposite effect.

“The previous Government took away the responsibility for providing 24/7 primary care cover from GPs,” he said. “I regret that, as it detracts from integration.

“It may also be responsible for placing a greater burden on accident and emergency departments at night.

“If out-of-hours care is not to be the responsibility of GPs, let it be centred, where geographically possible, on acute and community hospitals,” said Mr Lefroy. “This makes better use of NHS premises and, by being adjacent to A&E or other emergency units, can help take the pressure off them while providing the hospital with extra income.

 “That would certainly work at Stafford and Cannock.”

Mr Lefroy said tariffs were also responsible for producing ‘strange results’ referencing the block contract for A&E admissions in place at University Hospitals of North Staffordshire (UHNS).

“For any admission in excess of that, it receives only 30 per cent of the tariff, so what is it supposed to do, reject emergency admissions on the basis that they will be loss-making?

“Of course not.”

Mr Lefroy proposed instead emergency departments were funded at what it costs to provide a safe service.

“In Stafford, the emergency department has a deficit of some £2million per year based on throughput and tariff” he said. “The number of patients attending, more than 50,000, could not possibly be safely accommodated elsewhere.

“Surrounding hospitals are already at capacity, so it makes little sense to impose a national tariff, which inevitably results in a loss and which in turn puts pressure on the hospital to prove that it is sustainable.”

He said the third theme was the increasingly specialised nature of medicine which was leading certain services to migrate to large specialist units, and pointed out there was a danger in this direction.

“There are 61 approved medical specialties in the UK, compared with 30 in Norway,” said Mr Lefroy. “As the RCP says, this has ‘rendered the provision of continuity of care increasingly difficult’.

“For older people, who often have complex and multiple needs, this can result in poorly co-ordinated care,” he said. “This has not been helped by the introduction of shift-based systems under the new deal and the European Working Time Directive, to replace the teams that took responsibility for individual patients.

“Specialisation also means that there is a much smaller pool of staff from which to select for each post.”

He said if someone were to design a hospital from scratch where those who need it most, the elderly as the statistics show, would receive safe care for their complex needs as close to home and loved ones as possible, integrated into primary and community care, we would end up with something pretty much like the district general hospitals and community hospitals up and down the country, much like Stafford and Cannock.

“This is not an argument for no change,” said Mr Lefroy. “I believe there must be much closer working between the larger and smaller trusts, for instance, and much more sharing of common services than at present.

“But it is a warning that national tariffs are not impartial arbiters,” he said. “They generally work, I believe, against acute care.”

“There is a risk that the constant pressure which they are placing on acute care, particularly in district general hospitals, will make much of the sector unsustainable, yet without it, we do not have an NHS.”

Mr Lefroy said in closing he wanted to raise a specific point about the Monitor review of Mid Staffordshire NHS Foundation Trust.

“Clearly, the population served by the trust is a very important consideration,” said Mr Lefroy. “The trust’s 2011-12 report said that it was around 276,000, yet I have heard reports that the Monitor team considers it to be as low as 220,000 and therefore potentially too small to sustain certain services.

“The facts that I have clearly support the trust’s figure, not the one that I have heard rumoured.

“I have spoken much today about figures, because they are an important part of the Monitor review, but more important is the quality of services, for which Monitor also has a legal responsibility.”

He said early next year the Secretary of State for Health would bring the report of Robert Francis QC from his public inquiry into the trust.

“Julie Bailey and the Cure the NHS group, who from their own experiences brought to light the harm that was done, have set out radical and clear ideas for turning the NHS the right way up, with the patient at the top, not the bottom, right first time with zero harm to each and every patient,” said Mr Lefroy. “That is something which caring, hard-working staff in our NHS in Stafford and Cannock, where waiting times and mortality rates are improving, although there is much to be done, and right across the country went into the NHS to provide.

“The NHS, as John Healey said, and the nursing and medical professions must make it clear that there is no place for anyone for whom quality patient care does not come above all else. The regulations must show that.”

Mr Lefroy said the Monitor review was an opportunity for Stafford and Cannock hospitals to become models of how to provide sustainable, high-quality, emergency, acute and community care to a mid-sized population.

“If Monitor succeeds in achieving this there and elsewhere it will have done the nation a great service, and I am sure the Minister will be remembered as someone who played a major part in improving our NHS.

“I urge Monitor to rise to the challenge.”

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  • Staf Newsletter  |  December 22 2012, 1:40PM

    Jeremy Lefroy is raising a number of very important points here. It is good to see that he is actively questioning some of the key assumptions that Monitor are making. Financial Sustainability is the yardstick against which many hospitals throughout the country are now being judged, but I think that many of the comments that Mr Lefroy are making here indicate that this may not be the best approach to provide a coherent and cost effective service that meets the needs of the community. I would completely agree that there is a strong arguement for providing more care in the community and less in hospitals, but the experience of 2006/7 has already shown us very clearly that the starting point has to be to put the community services in place first, and make sure that integration works before you start thinking about cutting beds and nursing places. I also agree that Midstaffs does offer a genuine opportunity for the DoH to develop a blue print for the future of the District general Hospital. It is essential to see Mid staffs within a national context. One new piece of information that Mr Lefroy shares here is that we have an unusually high number of specialisms in this country, which may be impacting on our ablity to provide the care that people need close to their own homes. Whilst there is clearly some need to provide specialist treatment for some conditions it may be worth questioning how far this needs to go. Monitor are in a hurry. They want to "fix" Mid Staffs before the new financial year. I strongly hope that they can consider taking their time and ensuring that we get a solution that is right for our community.