Mid Staffs disaster will happen again

This week brought some closure to the Mid Staffs disaster with the publication of the Francis Report, which highlighted 290 recommendations supposed to ensure that a repeat of the systematic failings that led to the deaths of between 400 and 1,200 patients at the NHS trust will never happen again.

But all the evidence suggests that another Mid Staffs will happen.

A lot of the national press has been focusing on the human failings behind the incident, keen to scapegoat hospital staff and managers.

Yet this one-eyed point of view totally ignores the financial burden that Mid Staffs was under when these patients died over a three-year period from 2005 to 2009.

Lord Francis's first report into the care failings at the trust, published in 2010, says the hospital was required to make £10 million in savings at the end of 2006/7 - right in the middle of its crisis period - in its mad target-driven bid to achieve foundation trust status.

You'd have thought this would be warning enough about the dangers of putting bureaucratic targets above patient care.

But how has the government responded? By pushing through its Health and Social Care Act that demands all hospitals achieve foundation trust status.

Then we have the equally blind decision by this government to require the NHS to make £20 billion in "efficiency savings," as suggested by NHS head Sir David Nicholson - himself implicated in the Mid Staffs debacle.

Nicholson was head of the West Midlands Strategic Health Authority, responsible for supervising Mid Staffs, between August 2005 and April 2006 - at the outset of all the problems there.

So he's perhaps the most inappropriate person of all to suggest the NHS makes such colossal "efficiency savings" - which he lovingly dubs the Nicholson Challenge.

Hospitals should be warned that focusing too much on such "savings" will lead their trust down the same path that Nicholson played a hand in leading Mid Staffs.

Health Emergency campaign group director John Lister bets there are dozens of trusts at risk of being the next Mid Staffs through having to make savings in excess of £10m year after year.

Most recently in the news is Camden's Whittington Hospital in north London. It's so desperate to reach foundation trust status that it has been forced to cut £11m from its budget this year, with plans afoot to sell off its north site to private companies in order to bring in £17m.

The massive changes being proposed will also see its main hospital site downsized, with care transferred to community centres across north London.

Is this the price of becoming a foundation trust? And if so, is it worth the cost it will have on patient care?

It's interesting and timely to see that the other big story in the news this week relates to a hospital with a very different financial burden that has been shackled on trusts up and down the country - what MPs described as the "catastrophic" private finance initiative (PFI) debt saddled on Peterborough and Stamford Hospitals Trust.

The public accounts committee found that the decision to build Peterborough City Hospital under PFI while at the same time allowing private firm Circle to run Cambridgeshire's Hinchingbrooke hospital just miles away was made with a "complete lack" of strategic oversight by the Department of Health.

As a result Peterborough and Stamford Hospitals Trust has debts of £45.8m thanks to the extortionate loan shark-style repayments it is required to cough up under PFI - more than quadruple the deficit Mid Staffs found itself in.

For that you can thank Progress Health, the private company that holds the PFI contract.

And then there's Circle's woeful management of Hinchingbrooke, a not-so-glowing example of why privatising the NHS doesn't work.

With much fanfare Circle became the first private company to run a hospital at Hinchingbrooke last year. It claimed it would achieve £311m in savings over the 10-year franchise contract.

But in the first six months from last February the hospital's board reported a £4.1m loss, £2.2m more than expected.

Now the public accounts committee says the hospital needs a whopping £26m a year for the next 30 years in order to remain afloat - in total close to three times the deficit at Mid Staffs.

So here we have two financial disasters just 24 miles away from each other - with huge implications for patients and staff should they both need to be bailed out at the same time.

With many other trusts up and down the country struggling with their own PFI debts, and creeping privatisation sped up by the government's own ill-thought-out NHS reform, another Mid Staffs is more likely to happen than not.

The Department of Health says the NHS is in "robust financial health."

It was this kind of complacency that Lord Francis said helped to worsen the crisis at Mid Staffs in the first place.