Hospitals run by the scandal-hit Mid Staffordshire Foundation Trust should be downgraded, experts have said.
A number of services, including maternity care and some paediatric functions, should be stripped from Stafford Hospital and Cannock Chase Hospital, according a report by a team appointed by regulator Monitor.
The services should be provided by neighbouring trusts, the contingency planning team (CPT) said.
One in five patients would be sent to other trusts if the proposals are put into action, and the smaller hospitals run by Mid Staffordshire would “continue to meet the needs of four out of five patients”, Monitor said.
The CPT stressed that current services have a “clean bill of health” from the Care Quality Commission, but in a separate report, the experts said the trust, in its current form, is not clinically or financially sustainable in the longer term.
The trust was at the centre of a public inquiry into the “disaster” at Stafford Hospital where hundreds of patients may have died needlessly after they were “routinely neglected” between 2005 and 2009.
Last week, Monitor, which regulates foundation trusts, said it was consulting on putting the troubled trust into administration.
If the move goes ahead the trust would become the first foundation trust - a supposed marker of excellence in the NHS - to be put under the charge of special administrators.
Monitor said that if administrators are appointed, they will devise a plan for the reorganisation and delivery of services.
The report sets out a series of changes for the consideration of a trust special administrator - if one is appointed.
The CPT’s previous report concluded that the trust will not be able to provide safe care on a sustainable basis in the future.
Finances at the trust, which is deemed to be one of the smallest in the country, also have a bleak outlook. Last year the Department of Health was forced to give the trust a £20 million boost to maintain services for patients.
The latest report concludes that, to provide a sustainable service, the trust would retain two smaller hospitals at Stafford and Cannock.
But “serious care” and a number of services, including specialist surgical patients, paediatric inpatients and maternity services, would be provided at neighbouring organisations including University Hospital of North Staffordshire, The Royal Wolverhampton Hospitals and Walsall Healthcare Trust.
Professor Hugo Mascie-Taylor, head of the CPT’s clinical advisory group, said: “Our concern is that, given the low level of patient numbers and the temporary nature of many staff contracts at the trust, it will be difficult for the trust to maintain clinical standards in the long term.
“The CPT has therefore looked at how services could be reorganised in a way which would allow the trust to protect the quality of care that patients receive.”
Dr David Bennett, chief executive of Monitor, said: “Our aim as a regulator is to ensure that patients in Mid Staffordshire get good-quality services in the longer term.
“We appointed this CPT to investigate what might be necessary to provide sustainable services and we would expect the trust special administrators, if appointed, will use their work to develop a final recommendation for how services should be provided for the local community, including taking into account what options might be possible through joint working with other local providers.”
At a press conference in Stafford ahead of the release of the proposals, Dr Bennett said: “As everyone is very aware Mid Staffs is a trust that has had quite severe problems in the past.
“I’m pleased to say today that most of those problems are behind it, significant improvement has been made.
“But there are questions about the longer term sustainability of the trust. They’re facing falling numbers of patients and they’re already a quite small trust. They have problems with recruitment in some areas. There clearly is an issue over the sustainability of their finances. “In recent years they’ve had to rely on additional subsidy from the Department of Health.”
He said a consultation was taking place with the secretary of state over whether to appoint a trust special administrator.
An administrator would have 150 days to look at the recommendations made by the CPT. They would then put forward a final recommendation to the secretary of state for approval before any changes are implemented.
Dr Bennett said the trust would continue to operate as normal while a decision is made.
Professor Mascie-Taylor thanked staff at the two hospitals for their continued work during the “difficult circumstances.”
He said the challenge for the administrator would be to ensure the services offered to patients in Cannock and Stafford are safe and financially sustainable.
The size of the trust meant it struggled to achieve the standards expected, Mr Mascie-Taylor added.
Gill Cooksley, director of the CPT team, said they were recommending a smaller, local hospital in both Stafford and Cannock.
She said this would deliver local access to the most used services such as outpatient, ante-natal and post natal care.
Some patients needing specialist and emergency care would need to go to other hospitals but she said intermediate care would continue to be provided locally which would benefit the frail and elderly.
“The majority of patient attendances will remain where they currently exist so 83% of patient attendances will remain either in Cannock or at Stafford,” Ms Cooksley said.
She added that the vast majority of maternity care would continue to be provided in Stafford but that women would need to go to another hospital such as Stoke for the delivery.
Meanwhile 85% of paediatric services would continue to be locally delivered, she said.
However just half (50%) of accident and emergencies would be dealt with by Stafford or Cannock.
Blue light transfers for emergencies would also be affected by the proposals.
For patients in Stafford, she said their transfer time would increase by seven minutes however there would be little change, an average of around a minute increase, for those in Cannock, she said.
She said the currently reduced accident and emergency service of 14 hours a day would be replaced by around the clock care delivered through hospital physicians and GPs-led care out of hours.
The changes would benefit the patient as they would be seen by the most appropriate specialist, she said.
Overall four out of five patients would continue to receive care at Stafford or Cannock hospital under the proposals, Ms Cooksley added.