All 14 NHS Trusts investigated by Professor Sir Bruce Keogh’s review team will have to undertake strict improvement plans, while and 11 will be placed into ‘special measures’ – to ensure that his recommendations are fully implemented and patient care improves, the Health Secretary, Jeremy Hunt, announced in the House of Commons on 16 July.
Following the Francis Report into what the Department of Health dubbed ‘the tragedy at Mid-Staffordshire NHS Foundation Trust’, the Prime Minister asked Professor Sir Bruce Keogh, the NHS medical director, to conduct a series of ‘deep-dive’ reviews into other hospitals with mortality rates which have been ‘consistently high’ for two years or more.
According to the DH, the process was ‘thorough, and expert-led’, and consisted of both planned and unannounced and out-of-hours visits, placing particular weight on the views of staff and patients.
A DH statement issued on 16 July stated that Sir Bruce Keogh had found that, while there were ‘some examples of good care’, none of the 14 hospitals investigated was providing consistently high quality care to patients. The investigating team identified ‘patterns’ across many of the hospitals, including:
• ‘Professional and geographic isolation’.
• ‘Failure to act on data or information that showed cause for concern’.
• ‘The absence of a culture of openness’.
• A ‘lack of willingness to learn from mistakes’.
• ‘Ineffectual governance and assurance processes’. In many cases Trust Boards were ‘unaware’ of problems discovered by the review teams.
Specific examples of poor practice, meanwhile, included:
• Patients being left on trolleys, ‘unmonitored for excessive periods’, and then ‘being talked down to’ by consultants.
• Poor maintenance in operating theatres, ‘potentially putting patients in danger’.
• Patients often being moved repeatedly between wards ‘without being told why’.
• Staff working for 12 days in a row without a break.
• Blood being taken from patients in full view of the rest of the ward.
• Low levels of clinical cover – ‘especially out-of-hours’.
Professor Sir Bruce Keogh said: “Higher mortality rates do not always point to deaths which could have been avoided, but they do act as a ‘smoke alarm’ indicator that there could be issues with the quality of care. That is why I was asked to carry out a ‘deep dive’ inspection of the care and treatment being provided by each of these Trusts.
“Not one has been given a clean bill of health by my review teams. These reviews have been highly rigorous, and uncovered previously undisclosed problems. I felt it was crucial to provide a clear diagnosis, to write the prescription, and, most importantly, to identify what help these organisations might need to support their recovery, or accelerate improvement.
“Mediocrity is simply not good enough and, based on the findings from this review, I have set out an achievable ambition which will help these hospitals improve dramatically over the next two years.”
As a result of the reviews, the NHS Trust Development Authority and Monitor on 16 July placed all 14 Trusts on notice to fulfil all the recommendations made by the review for their hospitals. All will be inspected again within the next year by the new Chief Inspector of Hospitals, Professor Sir Mike Richards.
As a result of 11 of the 14 Trusts being placed into ‘special measures:
• Each hospital concerned will be required to implement the recommendations of the Keogh review, with external teams sent in to help them do this. Their progress will be tracked and made public.
• The Trust Development Authority or Monitor will assess the quality of leadership at each, and require the removal of any senior managers ‘unable to lead the improvements required’.
• Each hospital will be ‘partnered’ with high-performing NHS organisations ‘to provide mentorship and guidance in improving the quality and safety of care’.
Since 2010, the DH pointed out, each of the Trusts examined in the Review has seen ‘substantial changes to its management’, including a new chief executive or chair at nine of the 14. The DH added: “However, while some have improved, others have failed to do so, making today’s additional measures necessary.”
The three Trusts not going into special measures are Colchester Hospital University NHS Foundation Trust, The Dudley Group NHS Foundation Trust, and Blackpool Teaching Hospitals NHS Foundation Trust. While there apparently remain ‘concerns about the quality of care provided’ by these Trusts, the Foundation Trust regulator, Monitor, says it ‘has confidence’ that the leadership teams in place can deliver the recommendations of the Keogh Review.
As well as specific action to support the 14 hospital Trusts, the Government says it will also legislate ‘to make sure it will be no longer possible for failed managers to get new jobs elsewhere in the NHS’. The NHS Leadership Academy, meanwhile, will develop a programme that will ‘identify, support, and train, outstanding leaders’.
The 14 Trusts examined in the Keogh Review were: Blackpool Teaching Hospitals NHS Foundation Trust, North Cumbria University Hospitals NHS Trust, Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, Tameside Hospital NHS Foundation Trust, United Lincolnshire Hospitals NHS Trust, Basildon and Thurrock University Hospitals NHS Foundation Trust, Burton Hospitals NHS Foundation Trust, Colchester Hospital University NHS Foundation Trust, The Dudley Group NHS Foundation Trust, East Lancashire Hospitals NHS Trust, George Eliot Hospital NHS Trust, Sherwood Forest Hospitals NHS Foundation Trust, Buckinghamshire Healthcare NHS Trust, Medway NHS Foundation Trust.
