1. ITV Report

The 11 hospital trusts placed in 'special measures'

The Health Secretary said "fundamental breaches of care" uncovered in the Keogh Review Photo: Neil Hall/PA Wire

Mr Hunt said "fundamental breaches of care" uncovered in the Keogh Review had led to these steps being taken.

The trusts in special measures are as follows:

Tameside Hospital NHS Foundation Trust

Tameside General Hospital NHS Foundation Trust. Credit: ITV News

The review panel found patients that spoke of being left on unmonitored trolleys for excessive periods and there was a general culture of accepting sub-optimal care.

The report stated there were a number of systematic issues impacting on quality and patient safety including:

  • Insufficient senior clinical cover, especially out of hours
  • Lack of timely investigations and poor management of deteriorating patients
  • Poor bed management

North Cumbria University Hospitals NHS Trust

North Cumbria University Hospitals NHS Trust. Credit: Google Maps

The review panel found evidence of poor maintenance in two operating theatres, which were closed immediately.

It also found:

  • Significant weaknesses in infection control and prevention practices
  • Inadequate staffing levels and over-reliance of locum cover
  • Shortfalls in learning from serious incidents

Burton Hospitals NHS Foundation Trust

Burton Hospitals NHS Foundation Trust. Credit: PA Wire

The review found a number of urgent issues, including evidence of staff working for 12 days in a row without a break, inconsistent safety checks of medical equipment and an allegation that death certificates were not being completed in line with the trust's procedures.

The report warned there were issues with:

  • Clinical practice including escalation, delegation and supervision
  • Poor communication with patients and staff
  • A lack of trust-wide understanding of its quality objectives.

Northern Lincolnshire and Goole Hospitals NHS Foundation Trust

Diana, Princess of Wales Hospital (Grimsby). Credit: Diana, Princess of Wales Hospital (Grimsby)

Serious concerns were identified in relation to out-of-hours stroke services at the Diana, Princess of Wales Hospital (Grimsby).

The panel witnessed a patient who was inappropriately exposed where there were both male and female patients present, and the out-of-hours stroke services were deemed to be inadequate.

The report also found:

  • An emphasis on finance and targets were felt to detract from quality
  • Concerns over the staffing of the key elements of acute care
  • The early warning system was not taken up or universally understood

United Lincolnshire Hospitals NHS Trust

United Lincolnshire Hospitals NHS Trust. Credit: ITV News

Inadequate staffing levels and poor workforce planning was found, particularly out of hours. The panel had serious concerns about the way "do not attempt resuscitation" forms were being completed.

The Keogh Review found:

  • A lack of clarity around escalation procedures
  • Patient experience was not at the heart of the organisation
  • Lack awareness over the care patients with mental health needs should receive

Sherwood Forest Hospitals NHS Foundation Trust

Sherwood Forest Hospitals NHS Foundation Trust. Credit: ITV News

A public consultation heard from patients that were unaware who was caring for them, with buzzers going unanswered and poor attention being paid to all hygiene.

There was a significant backlog of complaints at the time that the panel visited, including complaints dating back to 2010, while other issues included:

  • Significant concerns over staffing levels at King's Mill and Newark Hospitals
  • Concerns over the number of patient moves
  • The trust did not appear to have a system to obtain feedback from patients

East Lancashire Hospitals NHS Trust

East Lancashire Hospitals NHS Trust. Credit: ITV News

The panel highlighted issues of poor governance, inadequate staffing levels and high mortality rates at weekends, including a high level of still born babies.

There were problems found in the following areas:

  • The complaints process was poor and lacking a compassionate approach
  • Quality processes were not cohesive
  • Managing high patient levels, particularly in A&E.

Basildon and Thurrock University Hospitals NHS Foundation Trust

Basildon and Thurrock University Hospitals NHS Foundation Trust. Credit: ITV News

The review panel identified at the time of its visit there were a number of issues including operational deployment, management and the payment of temporary staff - all of which were deemed to be a significant risk to patient care.

The report found that the trust needs to:

  • Review and improve its bed management and patient flows systems
  • Ensure infection control procedures are applied consistently
  • Review current staffing levels
  • Undertake focused work to improve reduce pressure in A&E

George Eliot Hospital NHS Trust

George Eliot Hospital NHS Trust. Credit: Joe Giddens/PA Wire

Low levels of clinical cover, especially out-of-hours, were discovered, growing instances of bed sores and too many unnecessary shifting of patients between wards.

Other urgent actions included:

  • Multiple bed moves were common during a patient's stay
  • Reporting on quality and mortality was found to be of unsatisfactory quality
  • It must improve plans for End of Life care outside hospital

Medway NHS Foundation Trust

Medway NHS Foundation Trust. Credit: Google Maps

A public consultation heard stories of poor communication with patients, poor management of deteriorating patients, inappropriate referrals and medical interventions, delayed discharges and long Accident and Emergency waiting times.

The Keogh Review urged the NHS trust to:

  • Review staffing and skill mix to ensure safe care
  • Improve consistency of early senior clinical review of patients, especially A&E
  • Implement a universal protocol to rapidly identify patients at risk of deteriorating

Buckinghamshire Healthcare NHS Trust

Stoke Mandeville Hospital, which is part of the Buckinghamshire Healthcare NHS Trust. Credit: Tim Ockenden/PA Wire

The report 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.

The Keogh Review warned:

  • There were concerns over staffing levels of senior grades
  • The trust's leadership appears "reactive" to issues
  • It needs to adopt national initiatives in developing a mature "safety culture"
  • It must provide assurance on the impact of major service change

Other NHS Trusts that were reviewed

The three hospitals not going in to special measures are:

  • Colchester Hospital University NHS Foundation Trust
  • The Dudley Group NHS Foundation Trust
  • Blackpool Teaching Hospitals NHS Foundation Trust