Setting out ‘ambitions’ for improved care

Following publication of Professor Sir Bruce Keogh’s review of the quality of care and treatment provided by 14 hospital Trusts in England, it was announced that all 14 of the Trusts – focused on because their mortality rates were consistently high for two years or more – will be undertaking strict improvement plans, with 11 of the Trusts being placed into ‘special measures’ to ensure that the Review’s recommendations are fully implemented and patient care improves. The hospitals will all be required to implement the recommendations of the Review, with external teams helping them to do so. 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 who are 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. The Review identified that, while there were some examples of good care, none of the 14 hospitals investigated was providing consistently high quality care to patients. Patterns were identified across many of the hospitals. These included: • 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. In the Review, Sir Bruce also set out a vision for where, he believes, 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’. The Care Quality Commission’s (CQC) new Chief Inspector of Hospitals, Professor Sir Mike Richards, has already announced the introduction of a series of radical changes to the way that hospitals in England will be inspected going forward. Inspections will be a mixture of ‘unannounced’ and ‘announced’ events and will include inspections in the evenings and weekends when patients have been found to experience poor care. The inspection teams will be bigger and will be headed up by clinical and other experts which will include trained members of the public. Teams will spend longer inspecting hospitals and will cover every site that delivers acute services and eight key services areas: A&E; maternity, paediatrics; acute medical and surgical pathways; care for the frail elderly; end of life care; and outpatients. Commenting on this move, Prof. Richards said: “These new-style inspections will allow us to get a much more detailed picture of care in hospitals. Inspections will be supported by an improved method for identifying risks and with much more information direct from patients and their families, and hospital staff. “The variety of Trusts selected will help to test CQC’s inspection model, which will be developed and refined this year, following consultation. It will also help us to develop the new ratings scheme for hospitals. For hospitals not covered by the new approach, we will complete our inspection programme for 2013-14, focusing on one or a small number of specific services with the hospitals that we think are most in need of inspection.”

Ambitions for the future

In addition to setting out a series of recommendations for the 14 hospitals looked at in the Report, Sir Bruce also set out a series of eight ‘ambitions’ identified by the review team as being achievable within two years and which will help tackle the causes of poor care across the wider NHS. These are: