Intended for healthcare professionals


Health secretary puts 11 hospital trusts in England into special measures

BMJ 2013; 347 doi: (Published 17 July 2013) Cite this as: BMJ 2013;347:f4602
  1. Zosia Kmietowicz
  1. 1BMJ

Eleven of 14 hospital trusts in England that were singled out in February for having higher than expected death rates have been put into “special measures” by the government and given 12 months to act on all the recommendations made in a review to improve the quality of care they provide.

All the 14 hospitals that underwent a “deep dive” review were found to have serious problems similar to those seen at Mid Staffordshire NHS Foundation Trust, though not on the same scale, said the medical director of the NHS in England, Bruce Keogh, who led the review.

The review team said they could not say that similar poor standards would not be found in hospitals around the country. Keogh said the review was a call for improvement in mediocre hospitals in England.

The prime minister, David Cameron, asked Keogh to investigate the trusts after the public inquiry into Mid Staffordshire NHS Foundation Trust found that high mortality was an early warning at the trust that ought to have been taken more seriously than it was.1 The 14 trusts were identified as they had the highest death rates in 2010-11 and 2011-12.

The review looked at the trusts’ hospital standardised mortality ratio (HSMR) and summary hospital level mortality indicator (SHMI) but also asked for patients’ and staff members’ opinions on the services provided and listened to focus groups involving staff and managers.2

Many hospitals were told to take immediate action in some areas. Two operating theatres were closed in North Cumbria University Hospitals NHS Trust because of poor maintenance records; the out of hours stroke service at Princess Diana Hospital in Northern Lincolnshire and Goole Foundation Trust had to be overhauled; unsafe shift patterns were changed at Burton Hospitals Foundation Trust; and in Sherwood Forest Hospitals Foundation Trust arrangements were made to deal with a large backlog of complaints.

These trusts were all put under special measures, along with Tameside, Basildon and Thurrock, East Lancashire, United Lincolnshire, George Eliot, Buckinghamshire, and Medway.

The review also found that many hospitals were operating in professional and geographical isolation and failed to act on data that showed cause for concern. They showed an absence of openness and of willingness to learn from mistakes. In many cases trust boards simply did not have the skills to adequately analyse clinical outcomes data, said Keogh.

Earlier the health secretary, Jeremy Hunt, had told parliament that there may have been many thousands of excess deaths at the hospitals. He said the NHS would not tolerate weak leadership and that “a consequence-free zone for managers would be banned.”

However, Keogh would not put a figure on the number of avoidable deaths that may have occurred at the 14 trusts, saying that measures such as the HSMR and SHMI were not robust indications that things were wrong. However, since 2005 HSMRs had fallen nationally by 35%, and in the 14 trusts investigated they had fallen by between 30% and 50%, he said.

Keogh said trusts needed to look out for several signs to evaluate how their services were operating, such as unhappy staff and patients’ complaints, as well as clinical outcomes.

He set out eight ambitions for the NHS that he said were achievable, including reducing numbers of avoidable deaths, better use of data to improve quality, ensuring an appropriate skills mix on wards, and better harnessing of the expertise and insight of England’s 50 000 junior doctors who see what was happening on wards.

Although concerns remained about the quality of care in three trusts—Colchester, Blackpool, and Dudley—these were not put in special measures because the regulator of foundation trusts, Monitor, was confident that leadership teams now in place could deliver the review’s recommendations.

Keogh told a press briefing on 16 July, “This is a difficult day for the NHS because we are laying bare some truths. On the other hand the transparency with which these reviews have been conducted will I hope be a turning point for the NHS.”

The Care Quality Commission, which checks all hospitals in England, was due to announce a new inspection regime on 17 July.


Cite this as: BMJ 2013;347:f4602


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