POLITICS
16/07/2013 18:31 BST | Updated 15/09/2013 10:12 BST

Listed: Eleven NHS Hospital Trusts Placed In Special Measures

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Health Secretary Jeremy Hunt has ordered investigations into higher than average mortality rates

Here is a summary of the reviews conducted into 14 hospital trusts which were investigated for having higher than expected death rates.

Health Secretary Jeremy Hunt said 11 of the 14 hospitals would immediately be placed into special measures. They are:

Basildon and Thurrock University Hospitals NHS Foundation Trust

The review found a culture of focusing on financial targets over quality of care.

It also found "an absence of organisational stability", criticising communication between ward level and the Trust board.

It also had concerns over out-of-hours cover at night and weekends, including the workload placed on junior doctors.

The four-hour waiting limit in accident and emergency (A&E) at Basildon University Hospital was "regularly breached", it found.

People were also being kept in the acute medical unit (AMU), designed to care for inpatients for a maximum of 48 hours, for up to 14 days with no access to showers.

Other hospital patients said they were discharged "inappropriately" and had to be readmitted.

There was also criticism of infection control.

The Trust serves around 400,000 people who live in south west Essex.

It has been ordered by the health regulator the Care Quality Commission (CQC) to make "immediate improvements" after officials raised concerns about Basildon University Hospital's standards of providing care and its ability to protect patients from harm.

It is also being closely watched by regulator Monitor for its higher than expected mortality rates, missing A&E waiting time targets, breaching its 18 week "referral to treatment" targets and governance issues.

The Trust said the review found numerous examples of good practice and praised its committed workforce, and had plans in place to tackle areas criticised.

Clare Panniker, its chief executive, said: "We welcome the feedback from the Keogh report. While it recognises a significant transformation programme is already under way here, we take very seriously the areas identified as needing urgent and further action and are addressing them as a priority.

"We welcome the support we will receive from an external team and the partnership with another NHS organisation."

Read: Patient's legs like 'Bits of raw meat' at Basildon Hospital

Buckinghamshire Healthcare NHS Trust

The review criticised the Trust boards "reactive" leadership for failing to understand or successfully tackle the causes of its high death rate over the past three to four years.

It found evidence that low staffing levels out of hours and at weekends caused delays in patients receiving essential treatments such as intravenous antibiotics and intravenous fluids.

Patients with special needs were not always treated on specialist wards.

Some patients reported that the quality of nursing care as sites including Stoke Mandeville Hospital was "variable".

The trust has previously been reprimanded by CQC for inadequate support provided to staff at Stoke Mandeville.

The regulator also raised concerns about staffing levels on some wards at both Stoke Mandeville and Amersham Hospital.

As well as main hospital sites at Amersham, Stoke Mandeville, it also has a hospital in Wycombe as well as five community hospitals at Thame, Marlow, Buckingham, Chalfonts and Gerrards Cross, and Waterside. The trust serves a population of half a million people.

Anne Eden, the Trust's chief executive, said the review found "no significant issues with the safety or quality of care provided at our hospitals".

"However, there were too many instances where patients and staff said we got it wrong and we accept that it is not good enough," she added.

"It is important for us to learn from, as an organisation and within clinical teams, to understand what we need to do differently into the future.

We will be looking at all patient complaints raised through this review to see whether they are already being dealt with or to identify any further action we could take. Patient safety and compassionate care are an absolute focus for us."

She added: "We recognise that in some areas, such as seven-day working, there is more we - like the rest of the country - need to do to ensure comprehensive consultant cover across the week and through the weekend."

Burton Hospitals NHS Foundation Trust

The review criticised poor communication between staff and patients.

Equipment safety checks were not being carried out.

There was a lack of support for junior doctors and poor rota arrangements leading to staff working long shifts.

There was poor infection control on the wards, including staff failing to wash their hands properly.

Nursing handover periods were reported by staff to be inadequate and there was a lack of continuity of care.

The Trust provides hospital based services at four sites with main operations in Burton-upon-Trent.

It serves a population of 360,000 people across South Staffordshire, South Derbyshire and North West Leicestershire.

The Trust has been told it must turn around its finances by regulator Monitor. Officials at the regulator also highlighted issues with the trust's board, although the Keogh report praised the "strong, united team at executive level".

Brendan Brown, its director of nursing said it had already completed all the work highlighted by the review as needing immediate action. This included recruiting 49 more nurses and additional consultants.

"I would like to reassure all of our patients that services at our hospitals are safe, and we will not tolerate standards of care that fall below those that we expect," he said.

East Lancashire Hospitals NHS Trust

The review criticised the Trust's inflexible and bureaucratic management structure.

Staffing levels were too low at the Trusts hospitals, including A&E and maternity units, with a high level of agency staffing.

In some cases it said there was staffing levels "insufficient to meet the basic needs of patients", leading to delays including in giving fluids or taking patients to the toilet.

Patients were being discharged early from Royal Blackburn Hospital to alleviate pressure while there were beds standing empty at Burnley General Hospital, it also found.

The medical complaints procedure was found to be "lacking a compassionate approach" with staff accused of being condescending to those who questioned care.

The trust runs five hospitals and other community sites across the region and caters for 521,400 people who live in East Lancashire, Blackburn and Darwen.

Mark Brearley, its chief executive, said it had plans in place to address problems, including immediate measures to improve staffing levels.

"This report strengthens our resolve to deliver zero tolerance of poor care, the report has identified areas of good practice and we intend to ensure that this is replicated across the organisation so that we can deliver the best care to all our patients," he said.

"The review team considered the caring and dedicated staff at the Trust to be a huge asset. However, they noted that staff were working at full capacity and we will be addressing these staffing pressures immediately.

"We are all committed to doing our utmost to ensure that patients are at the heart of all decisions and that our staff are inspired and enabled to deliver the care we all want to see delivered and that we are held to account if we fall short on this."

George Eliot Hospital NHS Trust

The trust board was criticised, with the review saying it was "difficult to identify evidence of proactive, driven leadership that is focused on excellent quality of care and treatment".

It was criticised for failing to internally analyse the reasons for its higher-than-average death rate.

There were also concerns over leadership of medical staff.

Staffing levels were low, especially out of hours.

Patients with a range of medical problems were being placed together on wards but it was "not uncommon" for them to be moved, leading to delays in treatment.

The care of pressure ulcers was also criticised.

George Eliot Hospital is a 352-bed district general hospital on the outskirts of Nuneaton in Warwickshire serving 125,000 in Nuneaton, and parts of north Warwickshire, south-west Leicestershire and north Coventry.

Its chief executive, Kevin McGee, said action had already started on the recommendations made in the report and that its mortality rate had improved.

He said the report had also praised its "outstanding and dedicated" nursing staff.

"What is clear from this review is that while we are on the right track to improving mortality rates, we need to increase the pace of change and as a small trust, we welcome any support to help us achieve this," he said.

"We are fully committed to addressing all the recommendations raised in the review and continuing to develop a clinically sustainable safe model of care that meets the needs of local people now and into the future."

Medway NHS Foundation Trust

The review found "potentially unsafe" staffing levels in some departments, with too few nurses and too many consultant locums being used, both during regular shifts and out of hours.

The over-stretched A&E department had an environment "unfit for purpose".

Some patients were potentially being admitted to hospital unnecessarily because of insufficient assessment by senior medical staff, including during out-of-hours periods and weekends.

The trust was also criticised for "a lack of clear focus and pace" at board level and among executives to improve patients' stays in hospital and their safety.

The Kent trust treats around 400,000 patients each year, with its main site at Medway Maritime Hospital.

The trust has been told it must turn around its finances by regulator Monitor. Officials at the regulator also reprimanded the trust for missing the four-hour A&E waiting times target for three quarters of 2011/12.

Chief executive Mark Devlin said many of the trust's improvement plans were at an advanced stage - including a review of nursing and midwifery that has been completed.

"I have recruited four new directors to the board, including a chief nurse from one of the top teaching hospitals in the country," he added.

"They bring a wealth of experience to their particular leadership remits for professional standards, patient safety, outcomes and experience.

"I'm also very pleased that our staff responded so positively to the review, seeing it as part of our culture of continuous improvement and high-quality care for our patients. They were encouraged that the panel recognised many examples of good practice."

North Cumbria University Hospitals NHS Trust

The report found inadequate governance, including a lack of support for staff from senior management.

It also criticised the pace and focus of changes designed to improve patient safety.

There was a slow and inadequate responses to serious incidents and "a culture which does not support openness, transparency and learning".

There were staffing shortfalls, especially out of hours, and too much reliance on locum staff.

Staff at the trust's hospitals also said they had not had sufficient time to complete mandatory training.

Equipment and buildings were poorly maintained and wards at West Cumberland Hospital were found to have "ingrained dirt and dust on surfaces".

There were significant weaknesses in infection control practices.

The Trust serves a population of 340,000 people from two main sites, Cumberland Infirmary in Carlisle and the West Cumberland Hospital at Whitehaven.

Ann Farrar, its interim chief executive, said the trust needed "a significant culture change" but warned that it would not happen overnight.

"Many of the areas highlighted are problems that we are acutely aware of and are actively working very hard to address," she said.

"Equally, however, there are areas of considerable concern where much better processes and procedures should have been in place to protect our patients.

"Together with our various health partners we are now taking very urgent action to address these issues in the very best interests of patient safety.

"There can be absolutely no excuses for some of the very poor standards that appear to have been accepted as the norm in North Cumbria over several years.

"It is important, however, that we now, collectively, look to the future and work together on this improvement journey, and I am encouraged that the Keogh Review team have recognised the work the trust has already done."

Northern Lincolnshire and Goole Hospitals NHS Foundation Trust

The review found a lack of clinical changes being made to improve care.

Care of patients in A&E at Grimsby Hospital was criticised, with some cases of ambulance staff found caring for them.

There were concerns over the staffing levels and skills of staff, including in areas including A&E, acute care and some medical wards.

Out-of-hours stroke services were found to be "currently inadequate" and there were concerns in other areas.

The trust was also found to be breaching national standards on mixed sex wards.

Northern Lincolnshire and Goole Hospitals NHS Foundation Trust serves a population of 358,000 people from three main sites: the Diana, Princess of Wales Hospital in Grimsby, Goole and District Hospital and Scunthorpe General Hospital.

The trust's chief executive, Karen Jackson, said: "There are no surprises in the final report. It reinforces what we already know and are working on, and reassures us that we are addressing the right issues.

"The majority of the recommended actions are already being implemented. However, we need to make more progress, faster.

"Patient safety and quality of care is always our top priority. People can be reassured that we are committed to putting our patients, their safety and well-being at the very heart of everything we do."

Sherwood Forest Hospitals NHS Foundation Trust

The review had "significant concerns" about staffing levels at King's Mill Hospital and Newark Hospitals. Half of nurses on the general wards were found to be "untrained".

A significant backlog of complaint to the trust dated back to 2010, and there were also long backlogs in producing discharge letters, arranging clinic appointments, and reading scans and X-rays.

It also raised concerns about the effectiveness of senior management at Newark Hospital and the trust's whistle-blowing policy.

The Nottinghamshire-based trust serves a population of 400,000 people, with two main hospitals, King's Mill in Ashfield and Newark Hospital.

The trust has previously been told it must turn around its finances by regulator Monitor. Officials at the regulator also reprimanded the trust for its "inadequate" governance.

Paul O'Connor, the trust's chief executive, said: "We were pleased that the (Keogh) national review team confirmed that there was no evidence of patient harm at our hospitals.

"However, we strive to provide good quality services to the many thousands of patients who use our hospitals each and every day, and that is why we will be responding to all of the recommendations contained in the report.

"We already had some actions in progress at the time of the review visit and we will now be taking whatever further actions are necessary to enable us to continue to improve our services."

Tameside Hospital NHS Foundation Trust

The review found a "culture of sub-optimal care" and criticised the board's lack of leadership.

A&E was singled out for urgent action to be taken, with low nurse staff levels, poor supervision of both junior doctors and patients, particularly at night, and poor infection control for patients coming in with Clostridium difficile (C Dif).

There was not enough senior clinical staff, particularly out of hours, and poor management of patients and beds.

There was no clear evidence that the trust was listening to patients and their families, or staff, to improve patient care.

Regulator Monitor is keeping a keen eye on the trust after it identified a failure in "governance arrangements and financial management standards".

Yesterday Tameside bosses were ordered to make "urgent improvements" by health regulator the Care Quality Commission (CQC). It found that Tameside General Hospital was failing to meet three of the four national care standards following two unannounced inspections.

Chief executive Christine Green resigned from her £150,000-a-year post two weeks ago following highly critical reports on patient care.

The Trust serves 250,000 people in part of Greater Manchester and Glossop in Derbyshire, centred around Tameside General Hospital in Ashton-under-Lyne.

Its interim chief executive, Karen James, said it would implement the review's recommendations "in full, openly and publicly, without exception".

"Standards of care have to be higher and our patients have the right to expect this. What is important now is that we work collectively with our health partners, look to the future and work with our staff within the hospital to raise standards further.

"I am encouraged that the Keogh review team have recognised the areas of excellence within the hospital - particularly our nursing staff. They also appreciate the work we have already done to address many of the issues raised.

"People can be absolutely reassured that we will work through the inevitable challenges that still lie ahead, with the support of our many thousands of dedicated and caring staff so that they can feel proud of their work, their organisation and the NHS.

"This is a new start for Tameside Hospital and we very much look forward to supporting it on this exciting journey of improvement and transformational culture change."

Read: Tameside Hospital criticised over levels of care

United Lincolnshire Hospitals NHS Trust

The review found inadequate staffing levels and shift planning, particularly out of hours.

Nurse staffing levels during one unannounced visit were so low the review team reported it to the CQC for investigation.

The review also found a "disconnect" between the board and senior clinical staff.

There was also criticism of the care of patients and the complaints procedure.

Mental health patients may not be getting the correct care because of a lack of staff training in mental health legislation, the review found.

United Lincolnshire Hospitals NHS Trust serves 700,000 people, with its main hospitals in Boston, Grantham and Lincoln.

The trust said it accepted the review, including more than 90 examples of things it did well.

But it added that it was spending £7 million this year and next year on hiring 200 more nurses from the UK, Spain and Ireland.

Eiri Jones, its interim director of nursing, said: "Historically, it has been difficult to fill all our vacancies, because clinical staff do not necessarily want to live and work in Lincolnshire.

"Recruiting to the additional posts are therefore a real challenge and we are using best recruitment practice to tackle this issue.

"While we are looking abroad, we also want to say to doctors and nurses in this country - come and work with us here, and help to make a real difference."