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Keogh review into 14 NHS hospitals did not find disaster on scale of Mid Staffs Keogh review into 14 NHS hospitals did not find disaster on scale of Mid Staffs
(2 months later)
The Keogh review into high death rates at 14 NHS trusts has not found a disaster on the scale of Mid Staffs, but rather the more banal spectacle of mediocre hospitals, struggling to meet one improvement target after another with little help.The Keogh review into high death rates at 14 NHS trusts has not found a disaster on the scale of Mid Staffs, but rather the more banal spectacle of mediocre hospitals, struggling to meet one improvement target after another with little help.
The review did not find killing fields but inadequacy. The trusts were unable to recruit the best people to turn the hospitals around because everybody in the NHS knew they were already failing. Chief executive heads are unlikely to roll in the wake of the reports, because few of those currently in place have been there very long.The review did not find killing fields but inadequacy. The trusts were unable to recruit the best people to turn the hospitals around because everybody in the NHS knew they were already failing. Chief executive heads are unlikely to roll in the wake of the reports, because few of those currently in place have been there very long.
In his overall findings, Sir Bruce Keogh, the NHS medical director, offers not a barrage of recommendations – the NHS has had enough of those, the team believes – but eight "ambitions". The thrust of the review is not to damn the hospitals but to help them improve. In addition to Keogh's overview, each trust has an individual report showing where it has been going wrong and what is already under way, with the help of the review team, to put it right.In his overall findings, Sir Bruce Keogh, the NHS medical director, offers not a barrage of recommendations – the NHS has had enough of those, the team believes – but eight "ambitions". The thrust of the review is not to damn the hospitals but to help them improve. In addition to Keogh's overview, each trust has an individual report showing where it has been going wrong and what is already under way, with the help of the review team, to put it right.
The 14 trusts were selected for an in-depth investigation in the wake of the excoriating Francis report into Mid Staffs because they had high mortality rates. But these were only the trigger for selection – an indicator that there were problems. Families who hold hospitals responsible for the deaths of loved ones, and their lawyers, may not be happy that the review has not investigated deaths.The 14 trusts were selected for an in-depth investigation in the wake of the excoriating Francis report into Mid Staffs because they had high mortality rates. But these were only the trigger for selection – an indicator that there were problems. Families who hold hospitals responsible for the deaths of loved ones, and their lawyers, may not be happy that the review has not investigated deaths.
In fact, the review team is sceptical about the death rates, which were estimated using two different mortality measures, which both have their weaknesses: the HSMR (hospital standardised mortality ratio) and the SHMI (summary hospital-level mortality indicator). In no uncertain terms, the review says: "However tempting it may be, it is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths."In fact, the review team is sceptical about the death rates, which were estimated using two different mortality measures, which both have their weaknesses: the HSMR (hospital standardised mortality ratio) and the SHMI (summary hospital-level mortality indicator). In no uncertain terms, the review says: "However tempting it may be, it is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths."
Many in the media have headlined the figures from Prof Sir Brian Jarman of Imperial College, who calculates that there have been 13,000 excess deaths in the 14 trusts since 2005.Many in the media have headlined the figures from Prof Sir Brian Jarman of Imperial College, who calculates that there have been 13,000 excess deaths in the 14 trusts since 2005.
But, the review says, it is wrong to talk of 13,000 needlessly lost lives. These are not all avoidable deaths. The team believes only a small percentage of these deaths could have been averted.But, the review says, it is wrong to talk of 13,000 needlessly lost lives. These are not all avoidable deaths. The team believes only a small percentage of these deaths could have been averted.
The 14 trusts were at the bottom end of the scale, but the review argues that only if they had been able to attract more highly skilled staff and invest more money in equipment and training would they have been able to match the results of the best.The 14 trusts were at the bottom end of the scale, but the review argues that only if they had been able to attract more highly skilled staff and invest more money in equipment and training would they have been able to match the results of the best.
Two eminent doctors and academics – Lord Darzi from Imperial College, who is a former junior health minister as well as heart surgeon, and Nick Black, professor of health services research at the London School of Hygiene and Tropical Medicine – will lead a team that will review hundreds of case notes from the trusts to find out the true extent of avoidable deaths.Two eminent doctors and academics – Lord Darzi from Imperial College, who is a former junior health minister as well as heart surgeon, and Nick Black, professor of health services research at the London School of Hygiene and Tropical Medicine – will lead a team that will review hundreds of case notes from the trusts to find out the true extent of avoidable deaths.
The review says that trusts have not themselves understood their data. Monitor, which regulates foundation trusts, and the NHS Trust Development Authority, which is tasked with getting other hospital trusts into shape to win foundation status, will be told to work with the 14 so they are better equipped to collect, analyse and understand their own results data, including training members of the boards. The review says many board members struggled to understand what the data meant.The review says that trusts have not themselves understood their data. Monitor, which regulates foundation trusts, and the NHS Trust Development Authority, which is tasked with getting other hospital trusts into shape to win foundation status, will be told to work with the 14 so they are better equipped to collect, analyse and understand their own results data, including training members of the boards. The review says many board members struggled to understand what the data meant.
There was some bad practice but, the review says, most of it was organisational. Some of the trusts were geographically isolated, such as North Cumbria, while others were professionally and academically isolated. Clinicians with ambition and drive and ideas would not choose to work there. The review says they must all be linked up to academic science networks, so they have close contact and exchanges with some of the country's top hospitals.There was some bad practice but, the review says, most of it was organisational. Some of the trusts were geographically isolated, such as North Cumbria, while others were professionally and academically isolated. Clinicians with ambition and drive and ideas would not choose to work there. The review says they must all be linked up to academic science networks, so they have close contact and exchanges with some of the country's top hospitals.
In a major departure, the review calls for young talent to be better used. It wants specialist trainee junior doctors to be given more responsibility and leadership roles. These are smart, younger doctors, aged in their mid-20s to mid-30s – an age at which businesses would be keen to promote them and listen to their ideas. In the NHS, they are too often treated as underlings of no account and with nothing interesting to contribute. That is a waste of talent, says the review.In a major departure, the review calls for young talent to be better used. It wants specialist trainee junior doctors to be given more responsibility and leadership roles. These are smart, younger doctors, aged in their mid-20s to mid-30s – an age at which businesses would be keen to promote them and listen to their ideas. In the NHS, they are too often treated as underlings of no account and with nothing interesting to contribute. That is a waste of talent, says the review.
Except for Tameside in Greater Manchester, all the excess deaths were in non-elective care – in other words, patients who arrived in hospital as urgent cases or in an emergency. Mostly, they were older people who may have had complex conditions.Except for Tameside in Greater Manchester, all the excess deaths were in non-elective care – in other words, patients who arrived in hospital as urgent cases or in an emergency. Mostly, they were older people who may have had complex conditions.
Keogh is already heading a further review into what should happen to accident and emergency departments, which is likely to recommend that they should be in fewer, specialist centres around the country, where expertise and skills can be kept at a higher level. But that will depend on setting up urgent care centres where there are now fully fledged A&Es to deal with the thousands who arrive wanting help but who are not in crisis.Keogh is already heading a further review into what should happen to accident and emergency departments, which is likely to recommend that they should be in fewer, specialist centres around the country, where expertise and skills can be kept at a higher level. But that will depend on setting up urgent care centres where there are now fully fledged A&Es to deal with the thousands who arrive wanting help but who are not in crisis.
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