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									Dear Graham (Irwin)

Future of MSFT

Stafford & Surrounds and Cannock Chase Clinical Commissioning Groups have
played a significant role in the development and delivery of the Clinical
Implementation Plan for MSFT over the past fourteen months. The Consortia
entered into the process fully committed to doing whatever was necessary to
build a “clinically safe and financially viable model” at MSFT. However,
despite everyone’s best efforts it is clear that a hospital, delivering a full
range of services, cannot be sustained.

Our Boards now believe that if we cannot achieve a plan which delivers a safe,
viable hospital that it is our duty to lead the development of a more radical
plan for the delivery of care for our patients.

We have had further discussions at our respective Boards to understand the
implications for both the Trust and the patients for whom we commission. The
clinicians have understood the need for a more radical approach to designing
what is delivered and have been frustrated by the lack of leadership from the
Trust. While we totally advocate the principles and reasons for holding the
recent LHE ‘Think Tank’
facilitated by ‘King’s Fund experts’, we were disappointed by the lack of
‘fresh thinking’ and radical options with which the event concluded.
The health economy has been charged with “thinking the unthinkable” and we
feel that as future Commissioners we have a duty to take this requirement

Before we share the model that we believe is right for Stafford and Cannock we
feel that it is important to set out why we feel this radical approach is the
correct one. Our future model has been arrived at based in part on the changes
that will be made to the delivery of care and in part from concerns over the
robustness of the financial planning around the Trust’s future.

Impact of CSIP on demand
First, the Long Term Care Strategy developed through CSIP and now adopted by
our Boards will revolutionise care. Over the coming two to three years the
demands of our patients will be transformed as a result of the care plans
developed for our most dependant patients and the co-ordination of care by the
case managers. The use of acute hospital services will be reduced in both
frequency and length with patients only being admitted for focused

The delivery of urgent care will also be significantly redesigned with
approximately 50% of the current activity being delivered through primary care
led Urgent Care Centres. The Centres will respond to the patient’s urgent need
and direct them into community services, where appropriate, which will further
reduce the demands on hospital care.

Financial Position of the Trust
Commissioners question the true size of the financial gap estimated at £11.4m.
The gap was quantified on the basis that all of the potential productivity
gains would be fully achieved. While we don’t doubt that the Trust will make
every effort to fully deliver the Productivity Gain, we think it unrealistic
to believe they will deliver the plan in full.
Therefore we believe that the gap will exceed £11.4m and for any plan to be
credible we need to aim to deliver a reduction in costs nearer to £15m if we
are not to risk future financial instability and the “slow death” of our

If we fail to ensure the future services in Stafford and Cannock are safe and
financially viable we will continue to find ourselves either being asked to:

• Bail out the Trust by funding above tariff as we did last year and the year
before using all of the SCR to ‘plug gaps’ rather than invest in development.
This pressure will grow each year and represents a lost opportunity of
investment for our patients in other areas of the local health economy.
• Accept lower quality as the Trust try to reduce support staff costs leaving
more tasks to be picked up by the clinical staff, or • Witness the slow demise
of the Trust as they struggle to recruit staff into financially compromised

At a CCG development workshop, which was attended by every Practice in
Stafford, potential models of care were explored. There was a strong
convergence on a model which delivers four specialities described below:

1. Urgent Care Centre – Providing an urgent response to minor trauma and
ailments which includes the management of limb fractures, wound care and pain
in the otherwise well adult and child. This needs to be integrated with the
OOH services to avoid duplication and waste.

2. Out-Patient Facilities – Delivered by one or more neighbouring Trusts on a
‘satellite basis’ i.e. locally to our patients who will then manage any in-
patient activity arising from the appointment, with the possibility of
rehabilitation care again delivered locally.

3. Diagnostics – Simple diagnostics such as X-rays in both Stafford and
Cannock with others being rationalised to one site.

4. Maternity – Midwifery-led maternity unit.

For all other specialities the clinicians believed that care could be
delivered either in the community or at other Providers such as UHNS, RWH, &

Key to delivering the high standards of care and quality, which the people of
Stafford and Cannock deserve, is the development of community based services
for the elderly and those with a long-term condition. As part of the model of
care we would envisage a shift of these specialities from secondary care into
the community. This supports the fuller integration of consultant expertise
with community nursing and social care thereby delivering high quality care,
which is able to manage people with complex care needs in their own home or
their local community.

We have shared this model with Cannock who, while wishing to explore this
further, broadly supports the more radical approach. Commissioners recognise
the political sensitivity of developing such plans and believe that these
changes could be delivered through a two site solution.

We understand that the Trust were to present a model to Monitor by the end of
January which should have Commissioner support. We are therefore surprised and
extremely disappointed that we haven’t had any further discussion of the Plan
despite our willingness to engage.

Finally, we are concerned that due diligence is given to the development of
the plans for the Trust. Any decisions taken will have long lasting effects
for both the local health economy and people of Stafford and Cannock. We
therefore request that any decision making regarding the future of MSFT
adheres to the principles of probity and are conducted in an open and
transparent manner that would stand the test of scrutiny wherever challenged.

Our present position is that until we are involved in the discussions
regarding the future of the Trust and receive assurance that anything more
that the four specialities above can be delivered safely and viably, as
responsible Commissioners, we could not support them.

We would welcome your urgent response and advice on how we can be fully
engaged in the development of the model of care for our patients.

Kind regards

Steve PowellJohnny McMahon
Chair, Stafford & Surrounds CCG Chair, Cannock Chase CCG

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