An investigation into care at hospitals with high mortality rates reveals that a number of organisations have become ‘trapped in medocrity’, according to NHS Medical Director, Sir Bruce Keogh.
Following the Francis report into the Mid Staffordshire scandal, the Prime Minister asked Sir Bruce Keogh to conduct a series of ‘deep-dive’ reviews into other hospitals with consistently high mortality rates. The investigation found that, while there were some examples of good care, none of the 14 hospitals were providing consistently high quality care.
The review identified patterns across many of the hospitals, including: 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, and ineffectual governance and assurance processes.
In many cases Trust boards were unaware of problems discovered by the review teams, such as: patients being left on trolleys and unmonitored for excessive periods, poor maintenance in operating theatres, staff working for 12 days in a row without a break, and low levels of clinical cover – especially out of hours.
As a result of the reviews, the NHS Trust Development Authority and Monitor have placed all 14 Trusts on notice to meet the recommendations made by the review. All will be inspected again within the next year by the new Chief Inspector of Hospitals, Sir Mike Richards. The Secretary of State also announced that 11 of the 14 Trusts will be placed on ‘special measures’.
Their progress will be tracked and made public; any senior managers unable to lead the improvements required will be removed; and each hospital will be partnered with high-performing NHS organisations to provide mentorship and guidance. The Government will also legislate to ensure that failed managers are unable to get new jobs elsewhere in the NHS.
Responding to the publication of the findings, Chris Ham, chief executive of The King’s Fund said: “The reasons for the kind of problems identified by the review are complex, but ultimately reflect poor leadership and a failure to develop the right culture of care at the hospitals identified. Small hospitals also face particular financial challenges and often struggle to secure sufficient staff.
“It is well known that some of the hospitals highlighted in the review have long-standing problems – most of them have already replaced their chief executives and chairs, so removing senior staff is unlikely to deliver the improvements needed. We therefore welcome the review’s recommendations, which provide a mixture of intervention and support to help the hospitals identified to improve, for example, by establishing partnerships with high-performing organisations.
“The review rightly emphasises the importance of hospital boards making better use of data to identify potential problems. High mortality rates should be treated with caution, but are an important warning sign. It is also important to look at other indicators, especially feedback from patients and staff.
“The review also highlights workforce issues, in particular inadequate staffing levels and a lack of experienced cover at night and at weekends – this emphasises the ongoing challenge for hospitals to provide adequate staff as the financial squeeze tightens especially given emerging recruitment difficulties in some parts of the NHS workforce. Responsibility for the quality of care in hospitals ultimately lies with front line staff and with boards – creating the right culture of care must be their top priority so that problems are tackled before investigative action is required.”
A copy of the report can be accessed at: http://www.nhs.uk/NHSEngland/bruce-keogh-review/Documents/outcomes/keogh-review-final-report.pdf
