Eleven out of 14 NHS trusts investigated by Sir Bruce Keogh for higher than average death rates have been placed into 'special measures' to help secure improvements to patient care.

The review - triggered by the Mid Staffs scandal in which up to 1,200 patients lost their lives because of care failings - found a hot pot of problems at each of the trusts preventing the provision of consistent high quality care.

Of extreme concern, Keogh found occurrence of ‘never events’ - such as operating on the wrong part of the body or retention of foreign objects post op - at 12 of the trusts under review, coupled with a failure to learn from such mistakes. 

General themes that arose include professional and geographical isolation, a lack of open culture, workforce issues and faulty governance.

The report did not, however, quantify the actual number of avoidable deaths at these trusts, despite a figure of 13,000 bouncing around various media reports before it was published, because it would be "clinically meaningless and academically reckless to do so", according to Keogh.

Nevertheless, addressing the House of Commons this week, Health Secretary Jeremy Hunt said that, since 2005, thousands more people may have died than would normally be expected at the 14 trusts, and he slammed the Care Quality Commission for failing to spot any cause for concern. 

All have now been placed on notice to fulfil recommendations made by the review in each of their hospitals, and of those in special measures senior managers will be removed if they fail to drive through these improvements.

Interestingly, 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, Hunt said.

External support 'key'

NHS Confederation chief operating officer Matt Tees told PharmaTimes that the worst performing trusts will need "considerable and sustained external support" to help them meet appropriate care quality standards.

They must embrace external expertise and establish networks - both with leading organisations within and outside the health service, such as the Academic Health Science Networks - in order to help counter the effects of the geographical and professional isolation that have played a key role in fuelling higher than average mortality rates in their hospitals, he said.

Another aspect raising eyebrows is that, of the 11 trusts placed in special measures, nine have been awarded Foundation Trust status, having passed the test for necessary standards for safe and quality care.

However, a spokesperson for Monitor told PharmaTimes that "as time has gone on, and in response to lessons learned from Mid Staffordshire, our assessment process has been significantly improved in a number of ways, including bringing in reviews of quality governance and seeking advice from the Care Quality Commission".

"Trusts and Monitor were already aware of some of the issues which have been raised by the review and were working to fix them - in five of the six Foundation Trusts going into special measures, we were already taking regulatory action," he stressed.

All 14 trusts will be inspected again within the next year by the new Chief Inspector of Hospitals, Sir Mike Richards.