Analysis: Hospital mediocrity isn't the problem - it's the failure to address it

The NHS needs a blame-free culture, a spirit of openness and the ambition to succeed

"Trapped in mediocrity" is the striking phrase Sir Bruce Keogh uses to describe the 14 poorly performing NHS trusts.

There is no scandal here on the scale of Mid-Staffs, nothing to justify lurid headlines at the weekend of 13,000 excess deaths.

But what Sir Bruce has uncovered is sufficiently disturbing: long-standing problems at each of the trusts which were widely known throughout the NHS but to which a blind eye had been turned.

It is not mediocrity itself that is the problem - somebody has to be below average - but the failure to address it. That is the real scandal.

Culturally and institutionally, the NHS is averse to acknowledging poor performance. Hospital death rates have been circulated to all NHS trusts since the late 1980s. When I got hold of a set and published them (in The Times) in the mid-1990s, I was besieged by calls from managers asking where the figures had come from (they had never bothered to look at them) and sued by surgeons at the worst performing trusts unhappy at having their work exposed to the limelight.

Nearly 20 years on, Jeremy Hunt warned last month that surgeons who declined to publish their death rates would be named and shamed. But the Keogh review suggests much remains to be done. It found leaders of the 14 trusts were still "struggling to understand and take advantage" of the death rate and other data available.

Mr Hunt today lambasted Labour in the Commons for ignoring quality and compassion in its "target-driven" NHS, to the fury of Andy Burnham, former Labour health secretary. But as Sir Bruce rightly notes, quality of care is only an issue for patients who can access it. Until 2008 the challenge for the NHS was that thousands couldn't. "The key issue was not whether people were dying in our hospitals avoidably but that they were dying whilst waiting for treatment."

Now the waiting list problem has been largely solved, we can focus on quality. It was high death rates that identified these 14 hospitals - but these are a smoke alarm, not a diagnostic test. It is as foolish to suggest the trusts were responsible for 13,000 excess deaths as that every woman with a breast lump has cancer.

The weekend headlines served only to alarm patients, demoralise staff and turn the public against a much cherished institution, for political gain. If the NHS is to improve, it needs, as Keogh says, a blame-free culture, a spirit of openness and the ambition to succeed.

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