CHIEF Executive of Monitor David Bennett talked exclusively to the Newsletter after members of the regulator’s Contingency Planning Team (CPT) announced recommendations to overhaul healthcare services in Stafford.
Dr Bennett answered questions on a number of subjects relating to the recommendations which will radically reconfigure services and could see the county town lose its intensive care unit, maternity services, A&E and some paediatric and specialist services.
The Newsletter asked Dr Bennett how he responded to comments of Stafford MP Jeremy Lefroy that an Intensive Care Unit (ICU) was crucial to a hospital in the town and losing it would lead to further services being forced out as well.
Dr Bennett said: “I think it is true that if you close the ICU it will have knock-on consequences.
“The question is can you operate a safe ICU and that's what the team has been focused on.
“I think that's where they're saying it's not clear to them that you can,” he said. “What I think is important is that they follow that logic through, so rather than just saying we will take a bit away and see what happens, I think what the team is trying to do is to say, well, if that's not sustainable, then what does that imply for this, this and this, and then trace it all the way through and say OK, the model that we propose has got to reflect all of that at the outset.”
We asked Dr Bennett if he was aware of comments made by Dr Lynne Hulme, a non-executive director at Mid Staffordshire NHS Foundation Trust who resigned this week alongside fellow non-executive director Eleanor Chumley-Roberts, saying she had been ‘marginalised’ and ‘made to feel irrelevant’ through the CPT’s lack of consultation or engagement with the board.
“First of all we do have to recognise that these are difficult processes we have to work through,” said Dr Bennett. “Because first of all you want to have free and frank discussions with people like commissioners and so on and you want to explore all sorts of options before you start narrowing it down.
“It's very easy, if things become public before you've had those discussions and started to reach conclusions, that there is a danger people run off and think you're going to recommend things which there's no likelihood you were ever going to conclude but you've nevertheless looked at them.
“So there is a need to do a certain amount of this, certainly in the early stages, so to speak, behind closed doors.
“I think a lesson for us in a situation like this where you've got a trust where the real problems are quite historic and the current board has been very much a part of the solution rather than part of the problem, is to find a way of involving them a bit more in the process.”
Dr Bennett said he didn’t think it was too late to do that and "For the next stage the TSA will be given a strong steer that they really need to draw on the knowledge and the expertise of the non-execs, and the governors. We really need to work harder at getting to people.
“I think we need to talk more to the governors and the non execs as well, even though they are technically suspended, they're still around and they have got a lot of expertise. What I think is there's a lot they can be doing both in helping the TSA run the trust but also in helping with a lot of the stakeholder engagement, so I think we should find a way of using that knowledge.”
The Newsletter asked whether a 30-day consultation was adequate given the complexities of the recommendations and the length of time they had taken to put together.
“The CPT has done a lot of the work already so the special administrator should be able to make use of that, so we're hopeful it should all be doable in the time available,” he said.
“I have to say the CPT has done more consultation than would normally be the case in advance of special administration.
“The time periods are set out in law, now we can extend some of them but we would have to believe there was something special about this situation that required us to do that but we will look at it.”
He said he hoped to appoint a TSA by the end of March and from that point they would have 45 days to produce their initial plan and then 30 days of public consultation.
“The form the consultation will take is left fairly open for the TSA,” he said. “There is good practice that they can follow, they could do more than that if they wished to and I think we will be encouraging them to make sure that the public consultation is in depth.”
We asked whether it would be appropriate for the TSA to come from Ernst and Young given their involvement in writing the report and the difficulties that might pose in challenging the detail of the report.
"The intention absolutely isn't that the TSA should challenge the report, they should take it as input and then build on it to reach their decision,” said Dr Bennett.
“Now they could reach a different conclusion, but it's certainly not the assumption that they are going to do that.
"So it could make a lot of sense for Ernst and Young to take on the TSA role, my problem is that I have got a professional procurement to go through to work out who does the next stage so I can't say who it will be.
"We do have to consult with a limited number of bodies including the secretary of state on the appointment of the TSA so it's a contingent process, so we're saying to potential administrators, if we do agree to go ahead with this, tell us what you would do, how much you would charge and so on.
“I'm hoping we will have it all done by the end of the month so both the consultation and the procurement are ready to go.
"We started informal discussions in the last couple of weeks because we knew where the CPT was coming out, so although there had to be a board decision and then a consultation we thought we'd start the informal discussions so that we could get them appointed as quickly as possible when it becomes formal.”
The Newsletter asked Dr Bennett if he could comment on the frustrations people would feel at losing a maternity service that has consistently been highly rated.
“One thing is, it's not just about having a maternity service; if it's a consultant-led maternity service, it's all the things behind it, and the second thing is, people's views, the royal colleges views for example, of what is the necessary scale of operation to make sure your consultants are operating with enough of the right sort of experience are changing and they are saying you need to be bigger in order to ensure that.
“So I think if we're going to make this change we've got to look to the future as well and say how are these requirements changing? What will it take to meet them in the future?
“There's how it is performing now and the guidelines it will have to meet in the future is one issue, the other is that you've got to look at the interconnection between all the services, so maybe in an ideal world where there was no interconnection, you could decide to do a different thing with maternity but you've got to reflect on the interdependency with other services.”
We asked Dr Bennett about the proposals for a new 24/7 emergency and urgent care and how they differed from the current A&E.
“One of the problems with this whole discussion around A&E is that different people have different ideas of what A&E is,” he said. “The essence of it is to say that unlike today, it will be providing a 24/7 service, but what's already started to happen, that the major trauma, the cardiac and stroke is going to stoke, there will be more of that.
“So where you've got serious emergencies, they will go straight to Stoke, where you've got the scale of the operation so that you can have all of the consultants. Then what you are left with, whatever label you put on it, is a 24/7 service.
Asked directly Dr Bennett confirmed this would be a walk in service. "It will be open 24 hours a day,” he said.
“This is the bit that needs more work, the team has said, possibly as much as half of the patients that are currently going to Stafford might go to Stoke, their expectation is that it will be less than that, but that's where they need to do the detailed work, to see exactly which services you can support in Stafford and therefore which ones, that aren't currently going to Stoke will in the future need to be taken there.”
The Newsletter asked Mr Bennett whether the increased pressure this could potentially place on West Midlands Ambulance Service was something that had been consulted over specifically.
Dr Bennett said he ‘believed’ the CPT had already spoken to the ambulance service but couldn’t say whether the changes would place an increased pressure on the ambulance service.
“The Ambulance service will certainly need to be prepared for that extra journey time,” he said. "I know they've been talking to them, I'm pretty sure they've been talking to them, and I don't think any major issues have been identified.
“In fact its the non-emergency services, so the elective services where I think the commissioners have acknowledged that there needs to be some improvement of access for those that don't have access to a private car, so some of the public transport isn't currently good enough, but there are ways of fixing that and they recognise that would need to be part of the answer.”