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Jeremy Hunt sets out plans to tackle mediocrity and inadequate leadership in the NHS

Sir Bruce Keogh’s review into 14 hospital Trusts in England published

All 14 Trusts investigated by Professor Sir Bruce Keogh’s review team will have to undertake strict improvement plans and 11 will be placed into “special measures” to ensure that Sir Bruce’s recommendations are fully implemented and patient care improves, Health Secretary Jeremy Hunt announced yesterday.

Following the Francis report into 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.

The process was thorough, expert-led and consisted of both planned and unannounced and out-of-hours visits, placing particular weight on the views of staff and patients.

Sir Bruce found that, while there were some examples of good care, none of the 14 hospitals investigated was providing consistently high quality care to patients. They identified patterns across many of the hospitals (the individual reports and recommendations can be found on the NHS Website) 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 include:

  • 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’s 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 of these trusts 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 have yesterday placed all 14 Trusts on notice to fulfill all the recommendations made by the review about their hospitals. All will be inspected again within the next year by the new Chief Inspector of Hospitals, Professor Sir Mike Richards, who starts work today.

In addition, the Secretary of State has today announced that 11 of the 14 Trusts will be placed into “special measures”, which will mean that:

  • Each hospital 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 hospital, requiring the removal of any senior managers unable to lead the improvements required; and

  • 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, each of the Trusts has seen substantial changes to its management, including a new chief executive or chair at nine of the 14. However, while some have improved, others have failed to do so, making yesterday’s additional measures necessary.

Three of the 14 hospitals are not going into special measures. They are Colchester Hospital University NHS Foundation Trust, The Dudley Group NHS Foundation Trust and Blackpool Teaching Hospitals NHS Foundation Trust. Whilst there were still concerns about the quality of care provided, the Foundation Trust regulator, Monitor, 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 will also legislate to make sure it will be no longer possible for failed managers to get new jobs elsewhere in the NHS. And, drawing inspiration from education where Super-Heads have helped to turn failing schools into outstanding ones, the NHS Leadership Academy will develop a programme that will identify, support and train outstanding leaders.

Health Secretary Jeremy Hunt said:

We have taken swift and tough action to make sure these hospitals are given all necessary support to improve. All 14 must fulfill all the recommendations made by Sir Bruce’s review and all will be inspected in the next year by the new Chief Inspector of Hospitals, Professor Sir Mike Richards.

I can announce that 11 hospitals will be placed into special measures to improve patient care. This means that they must implement all of the recommendations and external support will be provided to help them do this. The quality of leadership will be assessed and any senior managers who are not up to the job will be removed. And each hospital will be partnered with high performing NHS organisations to act as mentors.

Under the new rigorous inspection regime led by the Chief Inspector of Hospitals, if a hospital is not performing as it should, the public will be told. If a hospital is failing, it will be put into special measures with a limited time period to sort out its problems.

We owe it to the three million people who use the NHS every week to tackle and confront mediocrity and inadequate leadership head on. I would like to sincerely thank Sir Bruce and his team for their extremely difficult and thorough work.

Sir Bruce has also set out a vision for where the NHS can get to within two years. This includes:

  • Making demonstrable progress to reducing avoidable deaths in hospitals

  • Patients and clinicians will have confidence in the quality of assessments made by the CQC, not least because they will have been active participants in inspections

  • No hospital will be an island – professional, academic and managerial isolation will be a thing of the past

  • Nurse staffing levels and skill mix will appropriately reflect the caseload and the severity of illness of the patients they are caring for and be transparently reported by Trust boards

  • Patients will not just feel like they have been listened to but will be able to see how their feedback is impacting on their own care and the care of others

Notes to Editors

  1. The reports can be found here.

  2. For further enquiries, please contact the Department of Health Media Centre on 020 7210 5707 / 5896 / 5738 / 4939. Regional media should call the regional team on 020 7210 5724 / 4984.

  3. The 14 hospitals are: 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.

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