Mid Staffordshire NHS Foundation Trust, which runs Stafford Hospital where over 1,000 patients died unnecessarily, could be privatised, Unison has claimed.
With major debts (it is expected to be £46.6m in the red in 2014/15 and likely to incur debts of £14.5m every year, the trust is being looked at by the foundation trust regulator Monitor.
One option could be to put the trust "in special administration", which the union is suggesting could mean some level of privatisation.
Unison's head of nursing Gail Adams said: "Monitor should not fall into the trap of thinking that the answer to Mid Staffs' problems lie within the private sector.
"Improvements are being made at the hospital, but its problems cannot be solved overnight. The upheaval and uncertainty of turning the hospital over to a private company would only set this vital process back.
Hospitals in England could be on the brink of collapse because of rising demand and the increasing complexity of patients' conditions, doctors warn.
The Royal College of Physicians' report said the number of beds had been cut by a third over the past 25 years.
It said at the same time emergency admissions had started rising and hospitals were seeing older patients with a wider variety of conditions
The college said this process now meant urgent care was being compromised.
And it warned the problems could lead to another scandal like that surrounding the Mid Staffordshire NHS Trust, which became the subject of a public inquiry after regulators said poor standards had led to needless deaths.
The Royal College of Physicians (RCP) said standards were slipping in hospitals throughout England.
It cited the way older patients were repeatedly moved around wards, the lack of continuity of care while in hospital and tests being done during the night as some of the examples of how care was suffering.
The college also highlighted the results of feedback from its members, which showed concern about discharge arrangements and workload.
The report said in some ways the NHS had been a victim of its own success. Advancements in medicine had led to people living longer, but this meant they were increasingly developing complex long-term conditions such as dementia as a result.
Doctor Andrew Goddard of the Royal College of Physicians: ''The winter pressure is an all-year pressure''
Prof Tim Evans, of the RCP, said: "This evidence is very distressing. All hospital patients deserve to receive safe, high-quality sustainable care centred around their needs.
"Yet it is increasingly clear that our hospitals are struggling to cope with the challenge of an ageing population who increasingly present to our hospitals with multiple, complex diseases.
"We must act now to make the drastic changes required to provide the care they deserve."
The report said the solution lay in concentrating hospital services in fewer, larger sites that were able to provide excellent care round-the-clock, seven days a week.
But it also said this would require improvements in community services as there were many patients who ended up in hospital because of a lack of help close to home.
Jeremy Hughes, chief executive of the Alzheimer's Society, said: "These latest findings are alarming but, unfortunately, not surprising.
"It is painfully evident that the healthcare system stands on the brink of crisis.
"People with dementia are going into hospital unnecessarily, staying in too long and coming out worse."
Health minister Dr Dan Poulter said: "It is completely wrong to suggest that the NHS cannot cope - the NHS only uses approximately 85% of the beds it has available, and more and more patients are being treated out of hospital, in the community or at home.
"But it is true that the NHS needs fundamental reform to cope with the challenges of the future.
"To truly provide dignity in care for older people, we need to see even more care out of hospitals. That's why we are modernising the NHS and putting the people who best understand patient's needs, doctors and nurses, in charge."
A rescue package is being drawn up for a hospital trust accused of "appalling standards of care" three years ago.
Independent experts will look at a long-term solution for patients using Mid Staffordshire NHS Foundation Trust, health service watchdog Monitor said.
The watchdog, which oversees finance and management, said clinical care has improved but needs to be made sustainable.
Experts will look at how services can be made viable.
Financial advisors, accountants, administrative and legal service firms will form part of the team recommending how services should be run.
'Deeply dysfunctional'
Monitor said the body had an "open mind" about what solutions would be reached but suggested a solvent restructuring of the trust or possibly putting it in special administration could be options.
A final report will be delivered to Monitor in spring 2013.
The trust looks after Stafford and Cannock Chase Hospitals.
A 2009 Healthcare Commission report revealed a higher than expected number of deaths at Stafford Hospital.
After the placing of South London Healthcare into administration in July, this is another significant step for the NHS.
The decision by the health secretary two months ago was a first for the health service and could lead to that trust being broken up and services closed.
Mid Staffordshire is a foundation trust so this option is not open to ministers or regulators - yet.
But come April Monitor will have the powers to take the same step and so by announcing troubleshooters will be brought in Monitor has paved the way for that to happen.
It will not be the first time that outside experts have been asked to assess the governance and finances of an NHS trust.
But it is the first time they will have the remit to recommend administration for a foundation trust.
It is another sign that in the current financial climate tough action will be taken against struggling trusts.
A public inquiry into the role of regulators in the lead up to the critical report is set to report later this year.
The A&E unit is also temporarily shut at night and earlier this month an NHS report criticised the standard of breast cancer care, describing the set-up as "deeply dysfunctional".
A contingency planning team will work with local commissioners and clinicians, Monitor said.
Dr David Bennett, chair and interim chief executive of Monitor, said: "We have been working closely with Mid Staffordshire NHS Foundation Trust to improve its performance.
"It has made significant improvements in the clinical care provided for patients, but we need to make sure these services can be secured in the long-term.
"It is therefore time for us as the sector regulator to step in and look for a solution that ensures services are provided for local patients on a sustainable basis.
"We have an open mind about the form that solution might take, but it should be the best one for patients in the long term."
Lyn Hill-Tout, the trust's chief executive, said she welcomed working with Monitor so "clear decisions" could be made.
She said: "Reviews of the trust over the last few years and the changes to the way healthcare has begun to be provided nationally have led to a growing feeling of uncertainty about the future of the two hospitals."
Dr David Bennett: "We are open minded about what is the right answer"
In July a new medical director took over at the trust replacing Manjit Obhrai, who was brought in three years ago to improve standards.
At the same time, the Care Quality Commission lifted all of its previous concerns regarding the hospital, saying all "essential standards" were being met.
A Department of Health spokeswoman said the hospitals trust was "still facing serious financial challenges".
She added: "This puts at risk its work on improving services for patients.
"It is important that valued local services are sustainable and able to continue providing high quality treatment and advice for patients."
NHS announces new deadline to register claimsFor cases during the period 1st April 2004 – 31st March 2011 the deadline for individuals or their families and representatives to notify the relevant PCT will be 30th September 2012.For cases during the period 1st April 2011 – 31st March 2012 the deadline for individuals or their families and representatives to notify the relevant PCT will be 31st March 2013
Continue reading the main storyNHS staff from Great Ormond Street Hospital took part in the London 2012 Olympic Opening Ceremony
An agency will aim to link hospitals such as Great Ormond Street with foreign governments that want access to British-run health services.High-profile NHS hospitals in England are to be encouraged by the government to set up profit-making branches abroad to help fund services in the UK.
Investment would have to be drawn from hospitals' private UK work, but with profits ploughed back into the NHS.
A patients' group said the move was a "distraction" at a time of "upheaval".
The drive, building on an initiative first started under the Labour government, is set to be launched by the Department of Health and UK Trade and Investment this autumn.
The BBC understands the initiative is unlikely to involve regular district or general hospitals but would target world-renowned hospitals like the Royal Marsden, Great Ormond Street and Guy's and St Thomas'.
It would mirror schemes such as that of Moorfields Eye Hospital in London, which in 2007 built a unit of the same name in Dubai. Children's hospital Great Ormond Street also has interests abroad.
In 2010, Labour's Health Secretary Andy Burnham set up NHS Global to help the health service make the most of the global market for healthcare and the coalition now wants to build on this.
A source close to current Health Secretary Andrew Lansley emphasised that hospitals would be able to pay for their investments abroad using only revenue generated from their private patients in the UK.
Any profits made overseas would be ploughed back into the health service and so benefit NHS patients, the source added.
The Health and Social Care Act, which was passed by Parliament earlier this year, eased the way for hospital trusts to expand their work in the private sector.
Health Minister Anne Milton said: "This is good news for NHS patients who will get better services at their local hospital as a result of the work the NHS is doing abroad and the extra investment that will generate.
"This is also good news for the economy, which will benefit from the extra jobs and revenue created by our highly successful life sciences industries as they trade more across the globe.
"The NHS has a world-class reputation, and this exciting development will make the most of that to deliver real benefits for both patients and taxpayers."
Moorfields medical director Chris Canning said no taxpayers' money had been spent on its Dubai venture and it had been in profit for the past three years while "raising the reputation and profile" of the NHS and the hospital, and making money to reinvest in UK health services.
David Stout, deputy chief executive of the NHS Confederation, which represents organisations around England, denied the scheme would divert attention away from health services and said an international exchange of ideas could in fact improve local services.
"This is not about distorting what the NHS offers to UK citizens, this is about how we can exploit the brand of the NHS internationally," he told BBC Radio 4's Today Programme.
When asked if the NHS could end up under-funded by taxation because of increasing funds raised abroad, he said: "We are not talking about completely skewing the way the health service funding comes in - this will be marginal in the scheme of a £100bn organisation organisation in the NHS."
'Rampant commercialisation'
However, the move was criticised by the Patients Association.
"The key and only focus of an NHS hospital should be to provide treatment to patients on the NHS. We would be very concerned by any moves which would see commercial ventures, which are naturally going to be important for hospitals because they need to use them to raise revenue, would simply result in the attention of the hospitals being taken away from the core purpose - to treat patients in the UK and instead be focused on these hospitals abroad," said Michael Watson, of the group.
Andy Burnham, Labour: "The government's plan fundamentally alters the character of the NHS"
Labour began the initiative while in government, but shadow health minister Jamie Reed criticised the coalition's plans.
He said: "At a time when staff are losing their jobs and waiting times are rising, the government's priority should be sorting out the mess it has created in our NHS.
"Under David Cameron we're seeing a rampant commercialisation of the NHS. He needs to get a grip and start focusing on patients, not profits."
Thursday 10 May 2012
NHS 'can't cope' with multi-disease patients
GPs often have to deal with patients who have multiple health problems
The health system in the UK cannot cope with the rising number of under-65s with long-term medical conditions and needs "radical change", says a study in The Lancet.
A team of researchers analysing 1.75 million people in Scotland found that nearly a quarter had two or more chronic diseases.
Their care was often co-ordinated poorly and inefficient, the study said.
The team wants a more personal approach to patients with complex problems.
At present, healthcare services, medical research and the education of medical students are dominated by a focus on individual diseases, the study authors say.
Yet rising numbers of people are living with more than two long-term disorders, called "multimorbidity", which could include coronary heart disease, diabetes, cancer, stroke and depression.
In general, people with multimorbidity are more likely to live in deprived areas and have a poorer quality of life. Their care is fragmented because they see a number of different specialists.
Patients with multiple conditions need someone who can oversee all the problems of a patient.”
Prof Graham WattGlasgow University
Generalist approach
The study, led by Bruce Guthrie, professor of primary care medicine at Dundee University, Professor Stewart Mercer, of Glasgow University, and Graham Watt, professor of general practice at Glasgow, says this approach should change.
"Existing approaches need to be complemented by support for the work of generalists, providing continuity, co-ordination, and above all a personal approach for people with multimorbidity."
Their study of nearly two million patients registered with 314 medical practices in Scotland showed that people living in the most deprived areas were particularly affected by long-term physical and mental disorders.
These disorders were more common among poorer communities and occurred 10-to-15 years earlier than among those living in affluent areas.
The study looked for 40 chronic conditions among the participants' data.
Researchers found that 42% of patients had one or more conditions and 23% had two or more.
It also found that only 9% of those with coronary heart disease, had that one disease alone.
Similarly, only 23% of those with cancer, had only cancer and no other long-term disease.
'Wake-up call'
Although the prevalence of multimorbidity increased with age and was present in most people aged over 65, the actual number of people with multimorbidity was higher in those under 65, the study said.
Graham Watt, professor of general practice at Glasgow University, said this was a problem affecting many countries, not just Scotland.
This economic burden heightens the need to manage people with several chronic illnesses in more efficient ways.”
Dr Chris SalisburyUniversity of Bristol
"Any country with an ageing population is heading in this direction. All these countries are waking up to the problem.
"The status quo isn't an option because it leads in the wrong direction."
Prof Watt said that rather than more specialists, patients with multiple conditions "need someone who can oversee all the problems of a patient".
"These patients need continuity, and we need ways of measuring how well care is joined-up."
Financial burden
In an accompanying article in The Lancet, Dr Chris Salisbury, from the School of Social and Community Medicine at the University of Bristol, said the increasing proportion of people with several co-existing medical problems had a financial impact.
"Expenditure on health care rises almost exponentially with the number of chronic disorders that an individual has, so increasing multimorbidity generates financial pressures. This economic burden heightens the need to manage people with several chronic illnesses in more efficient ways," said Dr Salisbury.
Dr Salisbury suggests that general practitioners in more deprived areas should have lower caseloads to account for higher levels of multiple morbidity.
He also says that in hospitals, those with multimorbidity should be assigned to a generalist consultant who would be responsible for co-ordinating their care.
The Scottish Government's Health Secretary, Nicola Sturgeon, said: "We are working in partnership with NHS, primary-care providers and patients, as well as the research community, so that we have effective systems in place to address the needs of people with multiple health conditions and to reduce these health inequalities."
The unions representing nurses and midwives have joined others in stating their "outright opposition" to the government's NHS plans in England.
The Royal College of Nursing and the Royal College of Midwives had expressed concerns in the past, but said they were willing to work with ministers.
However, now they want the entire bill covering the changes to be dropped.
Health Secretary Andrew Lansley said the unions wanted to "have a go" at government about "pay and pensions".
The colleges' stance comes after a similar move by the British Medical Association last year.
It also mirrors the stance adopted by Unison, which represents a host of administration and support staff, such as porters.
But what impact this intervention has remains to be seen.
The Health and Social Care Bill is still working its way through Parliament, and the bill is in the Lords at the moment.
In many ways it is over the worst political hurdles and it seems the only way it could be stopped would be if the Lib Dems blocked it when it returns to the Commons - but that is considered unlikely.
On the ground, changes are already being made to pave the way for the new system to kick in, in 2013.
For example, while the doctors union is against it there has still been enough GPs coming forward to pilot the new plans in 97% of the country.
Anger
Under the plans, GPs are being put in charge of much of the NHS budget, while the health service is being opened up to greater competition from the private and voluntary sector.
In June the government announced a series of changes to the original proposals in the face of mounting opposition.
These included giving health professionals other than GPs more power over how NHS funds were spent, as well as watering down the role of competition.
The health unions initially gave the changes a cautious welcome, but they have been left disappointed by the finer details that have emerged during the parliamentary process.
One of the key developments was the news, which emerged just after Christmas, that NHS hospitals would be allowed to do 49% of their work in the private sector.
Peter Carter, general secretary of the RCN, which represents 410,000 nurses, midwives, support workers and students, said: "The RCN has been on record as saying that withdrawing the bill would create confusion and turmoil, however, on the ground, we believe that the turmoil of proceeding with these reforms is now greater than the turmoil of stopping them.
"The sheer scale of member concerns, which have been building over recent weeks, has led us to conclude that the consequences of the bill may be entirely different from the principles which were originally set out."
Cathy Warwick, of the RCM, said: "The government has failed to present sufficient evidence that its proposals are necessary. They have failed to present evidence that the upheaval will result in an improvement in services to the people of England.
"And they have failed to answer the concerns of the people who fear for the future of the NHS under these plans."
Savings plans
Both unions also expressed concerns that the changes were compromising the ability of the NHS to make the £20bn of savings it has been asked to make by 2015.
Mr Lansley said that nurses had previously been "right at the heart" of the process of planning reforms to the NHS to deliver better care for patients.
"The only thing that has happened in the last few weeks that has led to this situation with the Royal College of Nursing, is that the two sides of the Royal College of Nursing have shifted," he told BBC Breakfast.
"They used to be a professional association that was working with us on professional issues, and will carry on doing that, but now the trade union aspect of the Royal College of Nursing has come to the fore.
"They want to have a go at the government - and I completely understand it - they want to have a go about things like pay and pensions."
A Department of Health spokesman said: "The bill is needed to empower doctors, nurses, and other front-line healthcare workers across the NHS to take charge of improving care.
"We will continue to work with nurses and all other health professionals to ensure that the NHS delivers the best possible care for patients."
Shadow health secretary Andy Burnham said it was time to scrap the bill.
"A reorganisation on this scale needs a professional consensus for it to succeed. A year since the bill was introduced, it is abundantly clear that the government's plans do have failed to build that."
Analysis
The move by the two unions is unlikely to see the bill stopped in its tracks.
But it is clear the government's relationship with NHS staff is fracturing, possibly beyond repair.
Some inside government were saying the move by the royal colleges was being driven by their dissatisfaction over pensions.
That has undoubtedly played a role. So too has the drive to make £20bn of savings by 2015 - the equivalent of 4% of the budget a year.
This is putting more and more pressure on hospitals and waiting times in particular.
It means there is a toxic cocktail brewing inside the health service - and this spells trouble for the government.
It came to power saying - in private at least - that the NHS was its good news story, but all too often it is finding the headlines are negative.
