by Richard Vernalls
A scandal-hit hospital should be stripped of key services and the trust that runs it dissolved, administrators have recommended.
Mid Staffordshire NHS Trust was the focus of one of the biggest scandals in the history of the NHS when hundreds more people died than would normally be expected at Stafford Hospital.
The trust, which also runs Cannock Chase Hospital, went into administration in April after a report concluded it was not "clinically or financially sustainable".
Trust Special Administrators (TSAs) have now recommended a major shake-up, saying the trust is no longer viable and has severe financial problems - earning around £150 million a year but costing about £170m to run.
Stafford Hospital's A&E department should remain open between 8am and 10pm every day as at present, but maternity delivery services should close and children should no longer be admitted as inpatients to the hospital.
People who need major emergency surgery should be treated at other hospitals in the region, with only minor procedures continuing at Stafford.
Administrators propose retaining a small critical care area for very ill patients, and planned elective care and day cases should also remain, including orthopaedic surgery.
The report said some patients are "actively choosing" to use other hospitals and it was difficult to attract and retain enough doctors and nurses, partly due to the small size of the trust.
"The trust therefore has a high number of temporary staff which is very expensive," the report said. "It has also had to take on extra staff in recent years to improve care levels."
Healthcare currently provided at Cannock Chase Hospital should also stay as it is, according to the administrators' recommendations.
They noted the NHS nationally is already moving towards a model of providing care in larger specialist centres but said their recommendations would mean 91% of Mid Staffordshire patients would still be accessing care at the hospitals.
Stafford Hospital was the focus of a major public inquiry after it was found poor care may have led to the deaths of hundreds of patients as a result of maltreatment and neglect.
The Francis Inquiry highlighted "appalling and unnecessary suffering of hundreds of people", with some patients left lying in their own faeces for days, forced to drink water from vases or given the wrong medication.
That Inquiry followed a 2009 investigation by the Healthcare Commission which found between 400 and 1,200 more people died at Stafford Hospital than would have been expected.
If the latest proposals go ahead, it is anticipated the services identified to be migrated from Stafford Hospital will have moved across to neighbouring hospitals in the region within two or three years.
Those services will be provided in the main by the University of North Staffordshire NHS Trust, and The Royal Wolverhampton Hospitals NHS Trust, although the TSAs have identified other healthcare providers interested in taking on some aspects of care.
The consultation starts on August 6, and is running until October 1.
Dr Hugo Mascie-Taylor, who has been the clinical lead TSA, said Mid Staffordshire was simply too small to provide the adequate level of clinical care to patients.
"We believe the clinical services will be best delivered in partnership with larger hospitals," he said.
"In Cannock, we believe that is looking towards Wolverhampton or possibly Walsall, and in Stafford, that is looking towards Stoke.
"The key is wanting to provide safe and effective clinical services not to simply re-arrange the managerial deck chairs."
Dr Mascie-Taylor also said the Stafford Hospital scandal had also led to "enormous difficulty" in recruiting specialist staff, particularly in the hospital's A&E department meaning the status quo was not a realistic option.
By moving both hospitals into the control of neighbouring trusts, staff could be rotated between sites, solving staffing problems.
Karen Howell, co-founder of campaign group Support Stafford Hospital, said she was disappointed, describing the proposals as "unacceptable".
She said: "We've supposedly got A&E but actually it won't be a full service because the emergency surgery is being taken out - that is a downgrade.
"We've still got great concerns because they are taking away two vital services; that is paediatrics and midwifery which will be relocated to Stoke hospital, and those are the two most vulnerable groups in our society besides the elderly so I feel they are being put at risk through these proposed changes."
She said up to 30,000 "vulnerable people" in the community could have services affected and "their lives put at risk."
She added: "Whatever happens here and to the local services is going to happen elsewhere in this country where there are other general hospitals.
"It's not a Stafford situation, this is not local, it's national and I would stress to everybody that has a local general hospital that they should be warned.
"We need to fight, nationally and locally, now for our NHS services."
A spokesman for the Department of Health said people should contribute to the public consultation.
"We will, of course, carefully consider the recommendations when we receive them."
Mike Farrar, chief executive of the NHS Confederation, said administrators had "put forward some courageous proposals" to address issues at Mid Staffordshire.
He said: "The NHS is under intense financial pressure and Mid Staffordshire NHS Foundation Trust is not alone in its predicament. We have some really tough choices to make and we need to be honest and open about what these involve."