Feature Quality of Care

From “special measures” to “good” in less than a year

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1976 (Published 14 April 2015) Cite this as: BMJ 2015;350:h1976
  1. Matthew Limb, freelance journalist, London, UK
  1. limb{at}btinternet.com

Matthew Limb talks to some of the people responsible for turning a failing NHS trust around in less than a year

In July 2013, Basildon and Thurrock University Hospitals was one of 11 foundation trusts placed in special measures because of high death rates.

“It was a low point, a shock. Obviously we’d all rather be known for our excellent outcomes than our special measures journey,” says associate medical director, Charlotte Hopkins.

It also felt a “little late,” according to chief executive, Clare Panniker, who had joined the trust in September 2012 and had already begun to introduce radical changes.

“It was difficult” Panniker says. “For me, it felt this was a point when we were on a trajectory of improvement, but of course all of the trusts with a high mortality rate were put in special measures.

“So we used it as a way to galvanise more energy and more effort and improve the outcomes, to keep the improvement going.”

Hopkins says hospital staff overwhelmingly responded in the right fashion.

“I think hospitals that fight against what the regulators say are the ones that are in trouble. You’ve got to have insight and say, ‘Yes, we are falling short of the standard here,’” she says.

The journey out of special measures took 11 months and involved work on many fronts. The trust recruited more staff, opened new beds, restructured its leadership team, and brought in external advisers to support staff on a range of initiatives designed to help reduce mortality and avoidable harm, increase incident reporting and learning, and create a more open, sharing, and compassionate culture.

The trust “buddied” with another hospital, the Royal Free Hospital Trust, and developed a programme of work. This arrangement supported Hopkins’ secondment from UCL Partners to develop the trust’s quality improvement capability. …

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