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Health sector regulator puts six foundation trusts in special measures

Monitor has served notice on six NHS foundation trusts that they will be put in special measures to fix failings in patient care and hospital governance identified by Prof Sir Bruce Keogh.

New evidence was presented by the NHS England Medical Director’s independent review suggesting the following NHS foundation trusts were not complying with their licences: Basildon & Thurrock University Hospitals, Burton Hospitals, Medway, Sherwood Forest Hospitals, Tameside Hospital, and North Lincolnshire and Goole Hospitals.

Nine foundation trusts were chosen for the review on the basis of higher than average mortality rates in the last two years. Five of those trusts were already in special measures for breaches of the licence and therefore subject to a variety of existing sanctions by Monitor.

The Keogh inspection teams highlighted fresh evidence of poor practice or ineffectual governance in a number of cases. Monitor has therefore served notice to the trusts concerned that suspected breaches of the licence will trigger enforcement action.

Monitor considers that special measures are not warranted at this stage at three of the nine foundation trusts, but the trust boards will be called in to assure the regulator they are addressing all the issues found by the Keogh team. These are Blackpool Teaching Hospitals NHS Foundation Trust, Colchester Hospital University NHS Foundation Trust, and the Dudley Group NHS Foundation Trust.

Basildon and Thurrock University Hospitals is already in special measures, and has a new leadership team that is addressing the issues raised by the Keogh review. Monitor believes the improvements requested by the Keogh team can be delivered through existing measures and so no further enforcement action is proposed here.

Medway, Burton, Sherwood and Tameside are also already in special measures but Monitor judged that further intervention is needed in each case. These trusts are being asked to accept binding undertakings that they will deliver the Keogh action plan by a set date.

In addition, Medway is being asked to accept a binding undertaking that it will undertake a quality governance review, and Tameside that it will commission external reviews into the running of the trust Board and the maintenance of the quality of care throughout the hospital.

North Lincolnshire and Goole Hospitals is not currently in special measures but Monitor judges Keogh’s findings on patient care, clinical leadership and hospital governance all indicate breaches of its licence. The trust is being asked to accept binding undertakings that it will not only deliver the Keogh action plan but also commission reviews of clinical leadership and capacity to deliver improvements, and of  the governance of care quality.

In view of specific concerns raised by the Keogh review about clinical leadership at Burton, Tameside, and North Lincolnshire and Goole, Monitor intends to impose a further licence condition that would allow the regulator to make future changes to the leadership team at these three foundation trusts if necessary.

NHS foundation trusts subject to proposed enforcement action by Monitor have an opportunity to make representations before the regulatory measures are confirmed.

David Bennett, Chief Executive of Monitor, said: “The Keogh review has identified a number of serious issues at these foundation trusts, and we are taking appropriate action to ensure they are fixed as quickly as possible.

“These inspections will inform the future work of the new Chief Inspector of Hospitals, and we look forward to working closely with Prof Mike Richards and his new team at the Care Quality Commission to get prompt warning of emerging problems with patient care or hospital governance in future.”     

Notes to editors

  • For media enquiries please contact or phone  Jon Hibbs, Media Relations Director, on 020 7340 2446 (
  • Monitor is the sector regulator of NHS-funded health care services. Under the Health and Social Care Act 2012 its main duty is to protect and promote the interests of patients
  • Information about Monitor's role can be found here
  • Monitor's Enforcement Guidance sets out the procedure we follow when we become aware of a potential breach of the licence. Monitor has powers to (a) require foundation trusts to undertake certain actions, (b) accept binding undertakings from trusts that certain actions will be completed, and (c)  impose extra licence conditions which if not complied with could trigger the removal of the trust leadership (Chair, Chief Executive and/or Medical Director).
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  • Prior to the Keogh review, the enforcement position on the five trusts already in special measures was:
  • Basildon & Thurrock University Hospitals was in breach of its licence on governance grounds. Monitor has overseen the appointment of new leadership, and a number of independent reviews. We currently require the trust to implement a turnaround plan and to undertake a quality governance review.
  • Medway was in breach on finance and governance grounds, and required to deliver a financial plan and an urgent care recovery plan as well as put in place governance arrangements to implement them.
  • Burton Hospitals was in breach on financial grounds, and is required to develop a financial recovery plan, and obtain external assurance that previous reviews of board governance and quality governance have been implemented
  • Sherwood Forest Hospitals was put in breach on financial and governance grounds in September 2012 and Monitor has overseen the appointment of a new leadership and new governance arrangements. We currently require the trust to submit a five-year financial plan and continue delivering actions plans to improve governance.
  • Tameside was in breach on financial grounds and required by Monitor to secure its long-term financial and clinical sustainability by the end of 2015/16. In view of emerging safety concerns we wrote to CQC in May requesting a formal inspection which reported on Monday 15 July.

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