Oral Statement – Sir Bruce Keogh Review
Oral Statement in the House of Commons on the Professor Sir Bruce Keogh’s review of hospitals with high mortality rates.
Mr Speaker, I would like to make a statement about Professor Sir Bruce Keogh’s review of hospitals with high mortality rates, which is being published today.
Let me start by saying that in its 65th year this government is deeply proud of our NHS. We salute the doctors, nurses and other professionals who have never worked harder to look after each and every one of us at our most vulnerable. And we recognise that the problems identified today are not typical of the whole NHS, nor of the care given by many wonderful NHS staff.
But those staff are the ones who are most betrayed when we ignore or pass over poor care.
The last government left the NHS with a system that covered up weak hospital leadership and failed to prioritise compassionate care. The system’s reputation mattered more than individual patients, targets mattered more than people.
We owe it to the three million people who use the NHS every week to tackle and confront abuse, incompetence and weak leadership head on.
Origins of the Keogh Review
Following the Francis report into the tragedy at Mid-Staffs, the Prime Minister asked Professor Sir Bruce Keogh, the NHS Medical Director, to conduct a series of ‘deep-dive’ reviews into other hospitals with worrying mortality rates.
No statistics are perfect, but mortality rates suggest that since 2005 thousands more people may have died than would normally be expected at the 14 Trusts reviewed by Sir Bruce. Worryingly, in half of those Trusts, the CQC - the regulator specifically responsible for patient safety and care - failed to spot any real cause for concern, rating them as ‘compliant’ with basic standards.
Each of the Trusts has seen substantial changes to their management since 2010, including a new chief executive or chair at 9 of the 14. However, while some have improved, failure or mediocrity is so deeply entrenched at others that they have continued to decline, making the additional measures I announce today necessary.
This time, the process was thorough, expert-led and consisted of both planned, unannounced and out-of-hours visits, placing particular weight on the views of staff and patients. Where failures were found that presented an immediate risk to patients, they were confronted straight away rather than waiting until the report was finished.
We will be publishing all those reports today alongside unedited video footage of the review panel’s conclusions – all of which I am placing in the Library. I shall also today set out the actions the government is taking to deal with the issues raised.
I would also like to record my sincere thanks to Sir Bruce and his team for doing an extremely difficult job very thoroughly and rapidly.
Overall findings
Sir Bruce judged that none of the 14 hospitals are providing consistently high quality care to patients, with some very concerning examples of poor practice.
He identified patterns across many of them, including 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; a lack of ambition; and ineffectual governance and assurance processes.
In some cases, Trust boards were shockingly unaware of problems discovered by the review teams in their own hospitals.
So today I can announce that 11 of the 14 hospitals will be placed into special measures for fundamental breaches of care.
In addition, the NHS Trust Development Agency and Monitor have today placed all 14 trusts on notice to fulfill all the recommendations made by the review. All will be inspected again within the next 12 months by the new Chief Inspector of Hospitals, Professor Sir Mike Richards, who starts work today.
Those hospitals in special measures are as follows:
Tameside Hospital NHS Foundation Trust, where patients spoke of being left on unmonitored trolleys for excessive periods and where the panel found a general culture of “accepting sub-optimal care”.
North Cumbria University Hospitals NHS Trust, where the panel found evidence of poor maintenance in two operating theatres, which were closed immediately.
Burton Hospitals NHS Foundation Trust, where the panel found evidence of staff working for 12 days in a row without a break.
North Lincolnshire and Goole NHS Foundation Trust, where the panel identified serious concerns in relation to out-of-hours stroke services at Diana, Princess of Wales hospital. The panel also witnessed a patient who was inappropriately exposed where there were both male and female patients present.
United Lincolnshire Hospitals NHS Trust, where there were a staggering 12 ‘never events’ in just 3 years and the panel had serious concerns about the way ‘Do Not Attempt Resuscitation’ forms were being completed.
Sherwood Forest Hospitals NHS Foundation Trust, where patients told of being unaware of who was caring for them, of buzzers going unanswered and poor attention being paid to oral hygiene.
East Lancashire NHS Trust, where the panel highlighted issues of poor governance, inadequate staffing levels and high mortality rates at weekends. Patients and their families complained of a lack of compassion and being talked down to by medical staff whenever they expressed concerns.
Basildon and Thurrock University Hospitals NHS Foundation Trust, where there were 7 ‘never events’ in 3 years and concerns over infection control and overnight staffing levels.
George Eliot Hospital NHS Trust, where the panel identified low levels of clinical cover - especially out of hours, a growing incidence of bed sores and too many unnecessary shifting of patients between wards.
Medway NHS Foundation Trust, where a public consultation heard stories of poor communication with patients, poor management of deteriorating patients, inappropriate referrals and medical interventions, delayed discharges and long A & E waiting times. And Buckinghamshire Healthcare NHS Trust, where the panel found significant shortcomings in the quality of nursing care relating to patient medication, nutrition and observations, and heard complaints from families about the way patients with dementia were treated.
For these 11 Trusts, special measures will mean that:
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Each hospital will be required to implement the recommendations of the Keogh review, with external teams sent in to help them do this. Their progress will be tracked and made public;
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The TDA or Monitor will assess the quality of leadership at each hospital, requiring the removal of any senior managers unable to lead the improvements required; and
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Each hospital will be partnered with high-performing NHS organisations to provide mentorship and guidance in improving the quality and safety of care.
3 of the 14 hospitals are not going into special measures. They are Colchester Hospital University NHS Foundation Trust, The Dudley Group NHS Foundation Trust and Blackpool Teaching Hospitals NHS Foundation Trust. Whilst there were still concerns about the quality of care provided, Monitor has confidence that the leadership teams in place can deliver the recommendations of the Keogh review and will hold them to account for doing so.
Mr Speaker, this is a proportionate response in line with the findings of the review. Inevitably there will be widespread public concern not just about these hospitals but about any NHS hospital - and some have chosen to criticise me for pointing out where there are failures in care. But the best way to restore trust in our NHS is transparency and honesty about problems, followed by decisiveness in sorting them out.
The public need to know that we will stop at nothing to give patients the high-quality care they deserve for themselves and their loved-ones.
Today’s review and the rigorous actions that we are taking demonstrate the progress this government is making in response to the Francis Report. I shall update the House in the autumn on all of the wide-ranging measures that we are implementing, when the House will be given a chance to debate this in government time.
Conclusion
Mr Speaker, the NHS exists to provide patients with safe, compassionate and effective care. In the vast majority of places it does just this – and we should remember that there continues to be much good care even in the hospitals reviewed today.
But just as we cannot tolerate mediocre or weak leadership, nor must we tolerate any attempts to cover up such failings. It is never acceptable for government ministers to put pressure on the NHS to suppress bad news - because in doing so they make it less likely that poor care will be tackled. We have today begun a journey to change this culture. Those 14 failing hospital Trusts are not the end of the story. Where there are other examples of unacceptable care we will find them and we will root them out.
Under the new rigorous inspection regime led by the Chief Inspector of Hospitals, if a hospital is not performing as it should, the public will be told. If a hospital is failing, it will be put into special measures with a limited time period to sort out its problems.
And there will be accountability too: failure in the NHS should never be a consequence-free zone, so we will stop unjustified pay-offs and ensure it will no longer be possible for failed managers to get new positions elsewhere in the system.
Hand in hand with greater accountability will be greater support. Drawing inspiration from education, where superheads have helped to turn around failing schools, I have asked the NHS Leadership Academy to develop a programme that will identify, support and train outstanding leaders. We have many extraordinary leaders like David Dalton in Salford Royal and Dame Julie Moore of University Hospital Birmingham, but we need many more to provide the leadership required in our weaker hospitals.
At all times the government will stand up for hard-working NHS staff and patients who know poor care and weak leadership has no place in our NHS. It was set up 65 years ago with a pledge to provide us all with the best available care, and I am determined that the NHS will stand by that pledge. We owe its patients nothing less.
I commend this statement to the House.