On 9 June 2010 the Secretary of State for Health announced a full public inquiry into the role of the commissioning, supervisory and regulatory bodies in the monitoring of Mid Staffordshire NHS Foundation Trust.
Robert Francis QC delivered his final report to the Secretary of State for Health on Tuesday 5 February 2013. The report and Francis' recommendations were published on Wednesday 6 February 2013. A copy of the report is available on the Inquiry website.
Monitor issued a statement in response to Francis' report and this can be read here.
On 15 April Monitor announced the appointment of Trust Special Administrators to Mid Staffordshire NHS Foundation Trust. Read about this here.
The inquiry was established under the Inquiries Act 2005 and was chaired by Robert Francis QC, who made recommendations to the Secretary of State in February 2013 based on the lessons learnt from Mid Staffordshire. The final report built on the work of his earlier independent inquiry into the care provided by Mid Staffordshire NHS Foundation Trust between January 2005 and March 2009.
Monitor was a core participant in the inquiry and gave evidence in May and June 2011. More details are available on the public inquiry website.
Mid Staffordshire NHS Foundation Trust was authorised by Monitor as a foundation trust in February 2008. In March 2008, the Healthcare Commission started an investigation into apparently high mortality rates in patients admitted as emergencies to the trust since April 2005, and the care provided to those patients.
Throughout the period of the investigation Monitor worked closely with the Healthcare Commission and the trust board, to ensure that the trust was taking timely action to remedy the issues raised during the investigation. The Healthcare Commission published its report in March 2009, which identified significant failings relating to quality of care, governance and leadership within the trust.
Monitor intervened at the trust in March 2009 to appoint an Interim Chair (David Stone) and require the trust to appoint an Interim Chief Executive (Eric Morton). The key purpose of this intervention was to ensure that strategic and operational leadership was in place to stabilise the trust, enabling it to address the recommendations of the Healthcare Commission’s report, and maintain and build on the momentum of the improvements that had already been achieved.
Eric Morton’s appointment ended in July 2009 when he returned to Chesterfield NHS Foundation Trust. The Trust was not able to recruit a substantive appointment to the post of Chief Executive and Monitor formally intervened again in July 2009 to appoint Antony Sumara as Interim Chief Executive for a period of two years. At the same time, the trust’s board of governors appointed a substantive Chair, Sir Stephen Moss.
Monitor's Board took this action to ensure the trust had experienced leadership in place to take it through the next phase of its recovery. The Interim Chief Executive and Chair strengthened the Board and management of the trust, to ensure it sustained the progress it had made towards the delivery of improved patient care.
The Contingency Planning Team
Since 2009 the trust has made considerable and sustained improvements to the quality and safety of its services. We ensured that the trust focused on this as its first priority. However the trust now has serious financial problems which it cannot solve itself and it needs ongoing additional funding from taxpayers to keep going.
When it became clear that the trust was struggling to overcome these problems, a team made up of experts from Ernst & Young and McKinsey & Company, was appointed by Monitor in September 2012 following a competitive tender to examine viable long term solutions for providing services to patients in Mid Staffordshire.
The Contingency Planning Team (CPT) worked closely with local commissioners and clinicians, building on work already undertaken through the Strategic Health Authority to look into options for the provision of health care services in Staffordshire.
The CPT's final report (published 5 March 2013) entailed developing an evidence-based plan for reconfiguring local health care services that will deliver high quality, sustainable health care services to the population served by the Trust.
The CPT's proposed options would retain two smaller hospitals at Stafford and Cannock providing 24/7 emergency and urgent care, speciality out-patient and day case services (including screening, diagnostics and ante- and post-natal care) and care beds for the elderly.
Under the proposals, the two hospitals would continue to meet the needs of four out of five patients of Mid Staffordshire NHS Foundation Trust, with specialised and serious care being provided in due course by other local providers.
On 28 February 2013 Monitor started the procedure for putting the Trust into administration in order to safeguard services for local patients. Monitor is currently consulting with the Health Secretary and key organisations about the prospective appointment of Trust Special Administrators to lead the changes in Mid Staffordshire, the key organisations include: the Trust, local commissioners, the CQC and NHS England (previously called the NHS Commissioning Board).
Alongside our ongoing scrutiny of performance at the trust, in March 2009 Monitor's Board commissioned our internal auditors to conduct a lessons learned exercise to identify where Monitor’s processes and systems could be improved.
The internal audit report Learnings and Implications from Mid Staffordshire NHS Foundation Trust covered the period 1 October 2007 to 30 April 2009, and was published by Monitor in September 2009. The report made 14 recommendations, all of which were accepted by our Board, as detailed in our management response to the audit report.
An update on how we have improved our processes and systems was published in August 2010.
Key improvements made include: