Report casts doubt on Cannock and Stafford Hospitals' future

The review, undertaken by the watchdog after fears over Mid Staffordshire NHS Trust's dire financial position, has revealed a deficit at the trust of more than £19 million.

It also states Mid Staffs' finances have "deteriorated by over £24 million" since becoming a foundation trust in 2008. This is without taking into account the tens of millions of pounds ploughed into the service by the Department for Health. The trust has been deemed "financially and clinically" unsustainable and the report stated there is no "credible plan" to rescue it.

According to the report, Mid Staffs does not have "the level of staffing required to run a 24/7, high quality, consultant delivered service across a number of services including A&E, emergency services and paediatrics".

This is despite the trust increasing its pay expenditure by £9.1m on extra staff in 2010, which followed the scandal at Stafford Hospital between 2005 and 2008 in which up to 1,200 people died unnecessarily.

The chief executive at the time, Martin Yeates, resigned in 2009 when the scandal came to light. The report adds that the low staffing levels are partly due to "recent reputational challenges" which has made recruitment more difficult.

Monitor also claims that were Mid Staffs "to increase its minimum consultant levels, it is likely the number of patients referred to it would be insufficient for consultants to maintain their skills and experience".

This is partly because while Staffordshire has a population of 300,000 people, Stafford Hospital is the closest acute hospital to 175,000 by car. Cannock Hospital is not an acute unit and "much of Cannock is closer to Walsall and Wolverhampton hospitals than Stafford."

It also states "the usage of theatres in Cannock is low" – "with the utilisation of sessions at Cannock being as low as 60 per cent for the four orthopaedic theatres".

The report highlights the possibility of alternative use of the Brunswick Road site, which it says "could potentially increase the rentable value of the site and further reduce the existing outgoings by £1.5 million". It does, however, say "the estimated capital cost of achieving this is £5.4 million".

It adds: "It has been deemed that closure of the Cannock site is not within the gift of the trust's board, therefore alternative use of the site and the receipt of additional rental income is the main opportunity available."

Experts are now considering how services should be provided in a way which meets the needs of patients in the Mid Staffordshire area and is also sustainable.

This will include assessing whether some services should be moved to existing or new providers in the area and who these providers might be.

It will reflect the views of commissioners from Stafford and Cannock as to which services it is essential to maintain locally, says Monitor.

Stephen Hay, managing director for provider regulation at Monitor, said: "The team of independent experts have consulted widely in examining whether Mid Staffordshire is sustainable in its current form.

"Now we have the team's conclusions, it is important that they move forward quickly to find a way to safeguard services for patients in this area."

The report says that Mid Staffs is one of the smallest trusts in the country with relatively low levels of patients attending accident and emergency, and requiring non-elective surgery and maternity services.

This means the two hospitals at Stafford and Cannock Chase will find it increasingly difficult to provide adequate professional experience for staff and support them in the numbers recommended to maintain a high-quality service in the long term.

Mid Staffs would, however, be operationally viable due to the vast improvements made at the trust in terms of its operational targets, were a plan identified to make Mid Staffs sustainable in other areas, according to the report.

Lyn Hill-Tout, chief executive at Mid Staffordshire NHS Foundation Trust, said: "The board agrees with the Contingency Planning Team's assessment, which we first learnt about in December and is now summarised in their report to Monitor.

"We are pleased that the assessment, which has been detailed and thorough, has confirmed that we are operationally sustainable and have demonstrated this, over the last two years, through our consistently low mortality rates and low infection rates.

"We accept that Mid Staffs is not clinically or financially sustainable. The board concluded this was the case earlier last year and had discussed this with our regulator, Monitor. Monitor subsequently set up the review of the trust, and the Contingency Planning Team, through further detailed analysis, has now confirmed this."

Mrs Hill-Tout said the trust, like many smaller general hospitals, is not clinically sustainable in its current form. She says this is because medicine has and will continue to be more specialised, meaning smaller hospitals cannot compete in terms of attracting the specialist teams and infrastructure required.