Distinguishing unwise decision-making from lacking capacity
Dec 12 2023
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The Secretary of State has accepted the recommendations of the Trust Special Administrators for the dissolution of the Mid Staffordshire NHS Foundation Trust, which brings to an end the long and sorry saga of the Trust which has become synonymous with failure in the NHS. However, the statement does flag up some of the uncertainties which flow from the Trust Special Administration regime.
The TSAs recommended that Mid Staffs be dissolved, which was perhaps inevitable given the findings of the contingency planning team appointed by Monitor that the Trust was not sustainable either financially or clinically. The TSAs also made recommendations as to what happens next, both in terms of the clinical model for what services would be carried out where, and by whom. Stafford Hospital transfers to University Hospital North Staffordshire NHS Trust, and Cannock to Royal Wolverhampton Trust.
In the light of what happened subsequent to the TSA process in South London, where the CCGs have started to unpick the allocation of services through their commissioning responsibilities, it is significant that the focus of the Secretary of State's response is on what properly lies within his powers.
Monitor can dissolve a foundation trust in these circumstances and make an order transferring assets and liabilities – including current healthcare contracts. However the Secretary of State recognised in his statement to Parliament that the CCGs and NHS England as commissioners will be responsible in the longer term for decisions about where services will be provided.
Given the concerns expressed locally about the loss of services, it is not surprising that in addition to emphasising that 90% of the activity will continue to be provided where currently, the Secretary of State has held out the prospect of a continued consultant-led maternity unit at Stafford, notwithstanding the service recommendation of merely a midwife-led unit. This may be intended to reduce the risk of challenge by those who seek to preserve services in Stafford. It will be interesting to see how the pattern of services in fact develops, and indeed whether the effective takeover of Stafford hospital succeeds in maintaining services and continuing the improvements in quality.