New analysis of problems engulfing MidYorkshire Trust



The Press has been given exclusive access to this analysis of the situation at MidYorkshire Hospitals NHS Trust, the body which runs Dewsbury District Hospital. It appeared in the trade 



publication, Health Service Journal, and was written by their reporter Dave West. Sources told him the Trust may be split into three parts, with Dewsbury paired with Calderdale and Huddersfield... 





National policy



There is growing sentiment in favour of rationalising services to specialist centres which, where pursued, is likely to mean further (service) reductions at MidYorkshire.



An example is the ongoing development of major trauma centres in Leeds, Hull and Sheffield. 



This will increase serious cases dealt with away from MidYorkshire, probably reducing its income and making it even more difficult to attract A&E doctors.



The Government is ramping up efforts to abolish all NHS trusts, with all NHS providers in some form becoming foundation trusts.



When trusts fail to move through the pipeline the Department of Health has a series of policies, including replacing chairs and chief executives, seeking for the trust to be merged, acquired by others or seeking a management franchise.





Intermediate financial and performance position



The new chief executive (Stephen Eames) believes he can reasonably quickly improve the financial situation and performance against targets at the trust. 



Wellplaced sources said Mr Eames believes a set of relatively straightforward moves can improve waiting time target performance.



It is understood his approach is to improve the productivity and efficiency of service provision across a set of areas.



The trust also has a plan to make £23m of cost improvements in 201213 and break even financially.



It has announced moves to reduce workforce costs – including reduced hours and offering unpaid leave. If the plan fails, any alternative is likely to involve redundancies.



It is also acknowledged at the trust and in the health economy that it will not be viable in the medium term without significant service reorganisation. 



Service changes



Changes likely to be brought forward in a consultation, given previous work and indications from sources in the area, include:



• Extension of outofhospital care, preventative and stepdown services for people with longterm conditions, endoflife care and paediatrics.



That will allow a rationalisation (i.e. cuts) of hospital services, including:



• Centralise inpatient children’s care at Pinderfields;



• Centralise acute surgery at Pinderfields;



• Develop stepdown (convalescence) and stroke rehab care at Dewsbury and Pontefract;



• Possibly downgrade maternity services at Dewsbury to a midwifeled unit.



Changes on this scale, regardless of detail, are likely to provoke significant public and political opposition. 



Alternatives to MidYorkshire Trust



One option is for the whole trust to be taken over by another provider. But there are no obvious local candidates to take over such a large and struggling trust.



A takeover could involve mental health and community trust South West Yorkshire Partnership Foundation Trust, potentially partnered with a hospital trust.



More likely, though, is a breakup of MidYorkshire, with the constituent parts taken over by surrounding organisations. 



Several foundation trusts in the area could be interested. Calderdale and Huddersfield could consider taking on Dewsbury.



Barnsley Hospital Foundation may be interested in Pinderfields. The most likely to take over at Pontefract would be Leeds Teaching Hospitals Trust. 





Conclusion



In the short term, under strong new leadership, MidYorkshire looks likely to improve its position through a series of cost improvement and performance programmes.



It is also certain to move ahead with some smaller service changes over the next six to 12 months, working more closely with community and primary care services.



In addition, MidYorkshire’s severe cash shortfall, combined with the wider NHS financial outlook and national momentum for service change, means a further effort at significant reconfiguration is almost inevitable.



Over the next 12 to 18 months it will become clear whether these reconfiguration attempts are likely to succeed. 



Local leaders and national bodies will also have to decide whether they think the organisation is being turned around.



If they decide it is not, an alternative may be mandated, which is fairly likely to take the form of the threeway split described above.





• MidYorkshire told The Press an announcement on its future could be made as early as next month.





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