'Trapped in mediocrity': The damning verdict on the NHS as report reveals 14 hospitals had higher than expected mortality rates

Poor care, inadequate staffing and bad management behind deaths of patients at worst hospitals, says NHS chief

Charlie Cooper,Oliver Wright
Wednesday 17 July 2013 15:24
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Dozens of hospitals across England may have the “ingredients” of poor care, over-stretched staff and substandard management that led to the deaths of hundreds of patients in Mid Staffordshire, the Medical Director of the NHS warned today.

In a damming report into 14 hospitals with the highest mortality rates in the country Sir Bruce Keogh found they had become “trapped in mediocrity” ignoring concerns raised by patients and staff.

As a result of the inquiry 11 of the 14 hospitals are to be placed in special measures and will be subject to intense on-going inspections.

But Sir Bruce warned many other hospitals could have similar – but as yet unidentified – problems and called for new, more accurate, tests to identify failing hospitals.

A member of Sir Bruce’s review panel went further suggesting that the 14 hospitals investigated were not necessarily even the worst in the country.

In the House of Commons the Health Secretary Jeremy Hunt attempted to blame the previous Labour Government for the problems identified in Sir Bruce’s report.

He accused Andy Burnham, the Shadow Health Secretary of ignoring warnings of poor standards of care when he was in office and of “muzzling” regulators.

He also claimed that the mortality rates at the 14 hospitals concerned suggested that since 2005 “thousands more people may have died than would normally be expected”.

But Sir Bruce rejected this, warning that any attempt to use statistical measures to “quantify actual numbers of avoidable deaths” was “clinically meaningless and academically reckless”.

He added that during his long career in the NHS he had never felt under any pressure to suppress instances of poor care.

“In the discussions that I’ve had with ministers from both political parties I’ve never been asked to be engage in anything which I would have thought was a cover-up,” he said.

But Mr Burnham said Mr Hunt's “partisan” comments were “not worthy" of the report and claimed he did not have a “shred of evidence”.

He said Government briefings to newspapers over the weekend saying that the hospitals had been responsible for 13,000 additional deaths were part of a "cynical spin operation".

As he spoke, many Labour MPs shouted “smear” at Mr Hunt.

Sir Bruce’s report, which was ordered with the aim of quickly identifying other failing hospitals in the wake of the revelations about Mid Staffordshire earlier this year, found broader, systemic problems affecting the health service – but not of a similar scale to Mid Staffordshire.

At all 14 of the hospitals, effective care was hindered because of inadequate numbers of nursing and other staff, the report found. There was an over-reliance on temporary and unregistered staff and in some cases ward staff had to work 12 days in a row.

Complaints, when they were made took too long to be addressed or even acknowledged, the report said. Staff often felt unable to share concerns about the pressure they were under with senior managers.

Many of the 14 hospitals also suffered from being in “isolated” parts of the country, where it was hard to attract talented managers and senior medical staff, and care practice remained “behind the curve”.

“There is a sense that some of these trusts which are quite small or operating over several sites are operating in clinical isolation,” Sir Bruce said.

“Some of this is geographical isolation – and this leads to difficulties recruiting. They are not seen as centres of clinical excellence where aspiring doctors and nurses want to work.”

He added that too often the concerns of junior doctors were ignored.

“We have 50,000 junior doctors in the NHS who I don’t believe are sufficiently plugged into quality improvement programmes,” he said.

“I don’t think organisations listen to them as much as they should. We need to rectify that. What other industry would relegate people between the ages of 20 to their late 30s to simply being the worker bees?”

Mr Hunt said that “swift and tough” action would be taken to improve the hospitals. Eleven out of the 14 trusts have been placed under special measures and will be closely monitored by regulators. All 14 trusts will be subject to further inspections by the new Chief Inspector of Hospitals, Sir Mike Richards, who begins work on Wednesday.

But Professor Nick Black, a member of the review’s national advisory group, told the BBC that the 14 hospitals investigated were not necessarily the 14 worst in the country and that other trusts could have similar or worse problems.

“I think there are trusts out there that might be just as deserving of special measures and special review that might be just as deserving as those that were in the review,” he said.

The Royal College of Nursing (RCN) backed up the report’s findings.

“There is an undeniable link between nurse staffing levels and patient mortality and we can’t keep failing to address this issue,” said Dr Peter Carter, RCN chief executive. “…of course where there are examples of individuals delivering poor care these must be challenged and people must be held to account, but today’s review paints a picture of endemic poor leadership.”

Sir Bruce Keogh’s report sets out eight “ambitions” for the wider NHS in light of findings at 14 of the worst-performing trusts for mortality rates

  1. Reduce avoidable deaths with early warning systems for deteriorating patients and introduce more accurate statistical measurement of mortality rates.
  2. Expertise and data on how to deliver high quality care to be more effectively shared between NHS trusts.
  3. Patients, carers and the public should be more involved, and should be able to give real-time feedback.
  4. Patients should have more confidence in the regulator the Care Quality Commission, with wider participation of patients, nurses, and junior doctors on review teams.
  5. Hospitals in remote areas should not be left isolated, with staff from better-performing hospitals used to train and inspect others.
  6. Nurse staffing levels and mix of skills should be appropriate to the patients being cared for on any given ward.
  7. Medical directors should “tap into the latent energy of junior doctors” and include them in review panels.
  8. NHS employers should make efforts to ensure staff are “happy and engaged”.

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