Medical Mistake Claims - Simpson Millar LLP

Keogh report calls for improvements to patient care in hospitals

Author: Neil Fearn  Bullet  Dated: 26/07/2013

Following some delay and high expectation, the Keogh report on excessive fatalities at NHS hospitals has been published.

The review, under NHS England Medical Director Professor Sir Bruce Keogh, was set up earlier this year in the wake of the scandal at Mid-Staffordshire hospital.

Commissioned by the Government, Sir Bruce looked into treatment and care quality at 14 English hospital Trusts where death rates were viewed as excessive between 2010 and 2012.

Key mortality measures

The Trusts examined were ones that had recorded higher than average deaths according to key mortality indices, which compare:

  • Expected hospital death rates with the actual numbers
  • Individual hospitals' death rates

The Keogh report acknowledges that most problems which were immediately pinpointed had been promptly addressed. However, it presses for co-ordinated measures to improve long-term care and accountability.

On the back of the Keogh report, 11 Trusts will be subject to what the Department of Health terms 'special measures' to improve patients' conditions.

The goals of the Keogh review were to identify:

  • Any on-going failings in patient care quality at the 14 Trusts
  • The adequacy of the Trusts' quality improvement measures and whether further steps are necessary
  • Whether Trusts should have access to any further support
  • Areas which might need regulatory action for patient protection

What data did the Keogh review look at?

Conducted in 3 stages, the Keogh review looked into 6 main data elements connected with hospital performance:

  • Deaths
  • Patients' experience
  • Workforce
  • Clinical and operational effectiveness
  • Leadership
  • Governance

How was the Keogh review carried out?

Findings covering the 6 main data areas for each Trust were compared to national averages. Follow-up hospital visits then addressed particular areas of concern.

Sir Bruce's 15 to 20-strong teams of patients, doctors, nurses, managers and regulators conducted 2- or 3-day site visits without notice at each of the Trusts. The teams visited wards and spoke with patients, trainees, staff and senior managers, with findings noted promptly in 'rapid response' review reports. 1-on-1 interviews and some 70 staff focus groups were set up as part of a cultural assessment.

On completing the reviews, meetings were held with each trust to decide a co-ordinated action plan, including support to hasten improvements and identify individuals who are accountable.

What were the key findings from the Keogh review?

The following action has been taken at Trusts where areas for concern emerged:

  • Operating theatres immediately closed
  • Out-of-hours services for stroke patients suspended
  • Changes to staffing levels initiated
  • Patients' complaints backlogs to be dealt with

What were the common themes and barriers?

The report found that the common themes and barriers amongst the Trusts were:

  • A limited understanding of the importance and ease of truly listening to the opinions of patients and staff, then engaging with them to improve services
  • The capability of health chiefs to drive quality improvement by using data - this is made harder by difficulties in accessing data held in different locations and hospital systems
  • The complexity of using and interpreting key mortality indices

Keogh Report: the conclusion

According to Sir Bruce previously unexposed care problems had emerged, yet he warned against over-hasty reactions. Besides areas clearly in need of immediate remedy, the report found some instances where care standards were good.

Sir Bruce said: "We found pockets of excellent practice in all 14 of the Trusts reviewed. However, we also found significant scope for improvement, with each needing to address an urgent set of actions in order to raise standards of care.

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