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HSJ Live 16.07.2013: Keogh mortality review to be published today

Free live coverage of the publication of the final reports of Sir Bruce Keogh’s review of trusts with higher than expected mortality ratios, including reaction from across the centre and details of the criticisms of individual trusts.

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7.17pm Interview with health secretary Jeremy Hunt begins. Asked whether the day has been handled appropriately. Mr Hunt says that from today there is a new structure in place to deal with failure. “We’re being honest with the public and that is going to put pressure on everyone to [improve things]”, he said.

Jon Snow accuses politicians of “running the NHS ragged today” and questions Hunt over the 13,000 avoidable deaths figure used by some newspapers at the weekend.

In response Hunt says (paraphrashing): The excess mortality figure was a lead indicator for Mid Staffs… so when the Francis report was announced in February we started the review. He praises John Major’s government for setting up Ofsted.

“I took full responsibility today but we have to be honest that these are deep seated problems[dating back as far as 2005].”

 

7.13pm Ms Bailey says the “days of managers leading are over” and in future the frontline should be allowed to lead. Hunt interview coming up.

7.10pm Matt Tee admits the NHS has not been good enough at listening to patients in the past. “Today is a really challenging day for the NHS and I don’t think it’s helped when poiticians descend into point scoring.”

7.06pm Chief operating officer of the NHS Confederation Matt Tee and Cure the NHS founder are now being interviewed. Ms Bailey says she had been contacted by people who had suffered poor care at all of the hospitals involved.She said: “We’ve got a situation where we expect nurses to care for patients and we don’t care for nurses.” She says she sympathises with the Tory argument that Labour ignored concerns and former health secretary Andy Burnham refused to listen.

7.03pm The programme reports on the case of a patient who died at Buckinghamshire Hospitals Trust after mistakenly being fed solid food, despite the family telling nurses on a number of occassions.

7pm Channel 4 news also leads on the review, highlighting the political “fistfight” between Labour and the Tories over who’s to blame and noting that the number of avoidable deaths is unknown.

6.39pm HSJ editor Alastair McLellan attempts to bring some clairty to the debate over mortality rates and what they demonstrate. He tweets:

“Let’s be very clear. Keogh slams misleading USE of HSMRs “to quantify actual numbers of avoidable deaths” - not the stats themselves.”

6.24pm Colchester Hospital University Foundation Trust managers potentially put patients at risk by their “apparent lack of response to escalated patient safety concerns”, Sir Bruce Keogh’s mortality rates review said. Read the report on hsj.co.uk here.

6.18pm HSJ’s report into the issues identified at Tamside Hospital by the Keogh review is now online. The review has called for urgent action to address insufficient nurse staffing, inadequate supervision of junior doctors, and insufficient access to critical care beds at Tameside Hospital, HSJ’s North West reporter Crispin Dowler reports.

6.17pm The Keogh mortality review has asked Sherwood Forest Hospitals Foundation Trust to focus on the quality and safety of patient care rather than “meeting Monitor [performance]breaches in finance and governance”. Read HSJ’s report into the Keogh reviews criticism of the trust here.

6.12pm The NHS has little idea whether staffing levels in the NHS are safe, senior members of the Keogh review team have admitted. HSJ’s Shaun Lintern reports on the finding of the review that staffing levels on the wards of some of the trusts did not match the funded establishment and the admission from NHS England’s regional director of nursing for the Midlands Ruth May that she could not be sure staffing levels were “adequate across the NHS.”

6.06pm The BBC’s 6’O clock news leads with a report on the Keogh review. The King’s Fund Chris Ham says he can’t put his “hand on heart” and say the NHS can improve quality and make the savings required. The report notes that mortality has improved across the NHS over recent years, including at the review trusts.

5.36pm Peter Walsh, chief executive of the charity Action Against Medical Accidents, has criticised the government for failing to implement key recommendations from the Francis report.

He said: “The hospitals concerned should have been investigated years ago when high mortality rates were already known about.  In spite of the Mid Staffordshire Inquiry, Ministers are still refusing to accept key recommendations such as minimum staffing levels for wards and regulation of healthcare assistants.  We hope this report helps change their minds.It is time to put patient safety before politics.” 

5.33pm Regular HSJ contibutor Alison Moore tweets:

Can’t believe senior leaders of Keogh trusts who have been in place throughout the period looked at will stay for long.

Ben Clover points out it would “send a terrible message to NHS leadership if so” as Sir Bruce “good as said he didn’t know that performance was better elsewhere”.

5.30pm HSJ’s Ben Clover tweets:

1/2 I asked #Keogh if these problems applied across hospital sector. He said “I genuinely don’t know”. His report said…

2/2 boards often had no idea abt probs inside their orgs. So how confident can NHS leadership be they know what’s happening on the ground?

5.19pm Appearing on Radio 4’s PM programme Sir Bruce Keogh says NHS has been deluged with over 1,000 recommendations in the last six months and he is trying to show a way out.

5.12pm In response to comments from health secretary Jeremy Hunt that he does not know how the 13,000 figure “got out there” over the weekend, his opposite number in Labour’s shadow cabinet, Andy Burnham, tweets: “what rubbish”.

5.02pm Like the British Medical Association, the Royal College of Midwives is also urging the government not to use the Keogh review as “political ammunition”. This follows reports this morning that the Conservatives were planning to use the findings to undermine Labour’s record on the NHS.

In a ststement the college said: “The Government should be acting on its recommendations so that all patients no matter what they are going into hospital for can expect and receive the best possible care and outcomes.”

4.52pm Healthwatch England has published its response online.Like many commentators they say the Keogh review shows the problems at Mid Staffordshire are not a one-off but “clearly demonstrates there are broader problems in the NHS”. Healthwatch has contributed to the review at a national and local level.

The statement says: “In moving forward expressing outrage at the latest failure is no longer enough. The constant flow of negative stories is damaging. Consumers deserve a full and frank picture of any other existing problems across the country and critically they need to know what is being done to sort them out, and to have confidence they are the right solutions.

“The report makes it very clear the best source of intelligence is always from those at the frontline – patients and staff. Patients and staff are everywhere, all the time. Managers and regulators are not.”

4.45pm Responding to the Keogh review, General Medical Council chief executive Niall Dickson says the report “underlines” that the NHS has moved into a “much more transparent age when data and information about the quality of care will be in the public domain”.

“The challenge for all of us is to embrace this new world and work hard to analyse and better understand what it means,” he said.

Mr Dickson said the review also raised issues for the professionalism of doctors.

“Our guidance is clear that doctors must make patients their first concern and as this report demonstrates that means being able to raise concerns as well as listening to patients’ views and experience. That is the heart of professionalism and it must be the way forward for hospitals and other health care organisations.”

4.43pm A lack of “effective clinical leadership” was one of the main areas of concern at Northern Lincolnshire and Goole Hospitals Foundation Trust, HSJ’s Shreshtha Trivedi reports. The review has asked the trust to work with local comissioners to urgently address the provision of stroke services out of hours and noted that an “emphasis on finance and targets was felt by some staff to detract from quality, and that it was not obvious to some staff that quality was the priority”.

4.38pm Staffing on some of East Lancashire Hospital’s wards was “insufficient to meet the basic needs of patients”, a review of trusts with high mortality rates has concluded, HSJ’s Crispin Dowler reports. The Keogh review team’s report also noted concerns raised by staff had not been addressed. The trust announced the retirement of its chief nurse and deputy chief executive Lynn Wissett “with immediate effect” earlier today.

4.33pm Macmillan Cancer Support chief executive Ciarán Devane called for the NHS to listen to patients more in the wake of the review.  

He said: “The significant failings in patient care revealed by the Keogh review shows issues identified at Mid-Staffs are not unique to one hospital. The urgent priority is, as the Cavendish review said, for “intelligent kindness” to be the norm.

“We know that listening to patients through the Cancer Patient Experience Survey has been an effective way of driving up standards of cancer care. Staffing levels should ensure nurses have the time and space to communicate with patients.

4.30pm In a wide-ranging response Chair of the British Medical Association’s consultants committee, Dr Paul Flynn said the review demonstrated the need for a culture changein the NHS and more robust data.

He said: “Although we need to find urgent solutions to these problems, knee-jerk reactions are not going to be helpful. Short-term political gain only ignores the wider long-term challenges facing the NHS, and further risks patient safety. 

“Unless the Government is prepared to invest more into the NHS then there has to be a more honest debate about where and how finite resources are spent.

“We hope that the new Chief Inspector of Hospitals will now be given the political autonomy to be effective as the nation’s whistleblower and help restore the public’s confidence in the NHS.”

4.22pm Basildon and Thurrock’s chief executive Clare Panniker has spoken to HSJ reporter James Illman about the findings of the Keogh review. She said she accepted the report’s findings and that the trust still had significant issues to iron out.  However, she was pleased the report had not identified any new areas which the trust was not already aware of and working on.

4.14pm It is lonely at the bottom but the 14 Keogh review trusts need to be given support and space to improve not to be “buried under an avalanche of constant criticism”, argues HSJ editor Alastair McLellan in his leader on the review’s findings.

“A picture emerges of organisations cut off from the best practice that flows through the blood stream of the most successful trusts,” he writes.

4pm The King’s Fund has responded to the Keogh review. Chief executive Chris Ham said:

‘The reasons for the kind of problems identified by the review are complex, but ultimately reflect poor leadership and a failure to develop the right culture of care at the hospitals identified. Small hospitals also face particular financial challenges and often struggle to secure sufficient staff.

‘It is well known that some of the hospitals highlighted in the review have longstanding problems -  most of them have already replaced their chief executives and chairs, so removing senior staff is unlikely to deliver the improvements needed. We therefore welcome the review’s recommendations which provide a mixture of intervention and support to help the hospitals identified to improve, for example by establishing partnerships with high performing organisations.

‘The review rightly emphasises the importance of hospital boards making better use of data to identify potential problems. High mortality rates should be treated with caution, but are an important warning sign. It is also important to look at other indicators especially feedback from patients and staff.

‘The review also highlights workforce issues, in particular inadequate staffing levels and a lack of experienced cover at night and at weekends - this emphasises the ongoing challenge for hospitals to provide adequate staff as the financial squeeze bites, especially given emerging recruitment difficulties in some parts of the NHS workforce.”

3.51pm George Eliot’s mortality reporting ‘unsatisfactory’ says Keogh review 

George Eliot Hospital Trust must address concerns around its “unsatisfactory” reporting of quality and mortality and around patient safety, Sir Bruce Keogh’s mortality rates review team has said.

3.21pm Unite wade in with some good old fashioned union criticism of gov over Keogh. Head of health Rachael Maskell says: “Since Jeremy Hunt took up his job 10 months ago, he has been like a handwringing spectator blaming everyone else for the problems faced by the increasingly privatised NHS, except himself.

“He needs to roll up his sleeves and take responsibility for what is happening under his very eyes,” she says.

3.07pm Keogh finds disconnects at United Lincs The Keogh review has identified “lack of escalation procedures, inadequate staffing levels and disconnected leadership” as some of the key areas of concern at the United Lincolnshire Hospitals Trust. 

3.05pm Keogh review: Inadequate staffing and governance failures at North Cumbria

Keogh probe of trusts with high death rates found inadequate staffing and sustained failures to ensure adequate maintenance of estates and medical equipment at North Cumbria University Hospitals Trust @CrispinDowler reports

2.47pm Dean Royles, chief executive of NHS Employers, makes his contribution, noting that “staff and their managers will be particularly mindful of patients’ anxiety at this time”.

“We know that safe staffing levels are an essential element of care and we will work closely with the government as they work through and respond to the recommendations of this report,” he says.

“The report clearly highlights the importance of mortality indicators and how we can use them as a catalyst for change,” he adds.

2.34pm Thorough response from NHS Confed, which warns “there is no place in the NHS for senior leaders to bury their heads in the sand and avoid difficult lessons” from Keogh.

NHS Confederation CEO Matt Tee says: “Less than six months after publication of the Francis Report, we are experiencing another hugely challenging day for the NHS.

“Now more than ever, the NHS needs politicians to resist the temptation to descend into point scoring. It is crucial that we seize the opportunity offered by the Keogh Review to get under the skin of the NHS and shine light on its shortcomings but also recognises its successes.”

2.28pm In similar vein to RCN, Unison warns that unless the gov commits to safe staffing levels in the NHS, patients will not get the top quality safe, compassionate, dignified care they need and deserve.

Christina McAnea, Unison head of health, said: “We are pleased that the Keogh Review, as the Francis Report before it, has recognised the relationship between quality care and safe staffing levels. Spending pressures mean that health workers are losing their jobs.”

2.22pm Peter Carter, chief exec and general secretary of RCN, responds, noting the link between the 14 trusts and shortages of nurses - something college has campaigned on for while now.

He said: “We take this review incredibly seriously and have detailed examples of where we’ve raised concerns about patient safety in these Trusts.

“There’s an undeniable link between nurse staffing levels and patient mortality and we can’t keep failing to address this issue. Only with the right numbers of nurses, with the right skills, can we ensure patients are looked after with dignity and compassion.”

2.22pm And last (but not least) of all, here’s Blackpool Teaching Hospitals NHS Foundation Trust’s Keogh Review

2.21pm Keogh on Colchester Hospital University NHS Foundation Trust and East Lancashire Hospitals NHS Trust

2.21pm Here’s the Keogh report on North Cumbria University Hospitals NHS Trust and also Northern Lincolnshire and Goole Hospitals NHS Foundation Trust

2.20pm Eleven trusts put in ‘special measures’ following Keogh review. Eleven of the 14 hospital providers investigated because of high mortality ratios have been placed in “special measures”, the health secretary has announced.

2.15pm Keogh review report on Sherwood Forest Hospitals NHS Foundation Trust and on Tameside Hospital NHs Foundation Trust

2.13pm Here’s the individual Keogh report for Basildon and Thurrock University Hospitals NHS Foundation Trust

2.06pm And here’s the report on Dudley Group NHS Foundation Trust and also the report on United Lincolnshire Hospitals NHS Trust

2.02pm Here’s a link to the specific Keogh report on Buckinghamshire Healthcare NHS Trust and also the link to the report on Burton Hospitals NHS Foundation Trust. More to follow…

1.57pm Of the 14 trusts investigated by Keogh, 7 have made over 1,100 nursing job cuts since the election claims @labourpress

1.55pm Michelle Mitchell, charity director general of Age UK, is quick out of the traps with Keogh response. She says: “Today’s report will be deeply concerning for many older people and they will want to know that a robust plan is in place to address any on-going problems identified in those hospitals.

“However we are only too aware that many of the issues raised are not unique.”

1.54pm Health regulator Monitor tells HSJ it is using its powers to secure improvements in patient care and hospital governance at six foundation trusts identified as failing on these issues by Prof Sir Bruce Keogh’s recent Review.

1.50pm NTDA to send teams into Keogh review trusts HSJ understands no hospital chief executives will face immediate removal from post as a result of the Sir Bruce Keogh’s review into mortality rates @BenClover reports

1.48pm Resignations announced at Keogh review trust.

East Lancashire Hospitals Trust today announced the resignations of its chair and its deputy chief executive, minutes before the expected publication of the Keogh review’s report on the trust. @CrispinDowler reports

1.35pm Annex A of the Keogh Review report contains the headline findings for all 14 trusts examined by Sir Bruce and his team.

1.28pm: Jeremy Hunt said the trusts in special measures would be subject to further reviews in the next 12 months, support teams, and be partnered with high performing hospitals.

1.27pm: The DH has issued a statement on the outcome of the mortality review:

All 14 Trusts investigated by Professor Sir Bruce Keogh’s review team will have to undertake strict improvement plans and 11 will be placed into “special measures” to ensure that Sir Bruce’s recommendations are fully implemented and patient care improves, Health Secretary Jeremy Hunt announced today.

Following the Francis report into the tragedy at Mid-Staffordshire NHS Foundation Trust, the Prime Minister asked Professor Sir Bruce Keogh, the NHS Medical Director, to conduct a series of ‘deep-dive’ reviews into other hospitals with mortality rates which have been consistently high for two years or more.


The process was thorough, expert-led and consisted of both planned and unannounced and out-of-hours visits, placing particular weight on the views of staff and patients.

Sir Bruce found that, while there were some examples of good care, none of the 14 hospitals investigated was providing consistently high quality care to patients. They identified patterns across many of the hospitals (the individual reports and recommendations can be found at www.nhs.uk) 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; and
- ineffectual governance and assurance processes. In many cases Trust Boards were unaware of problems discovered by the review teams.
-

Specific examples include:

- patients being left on trolleys, unmonitored for excessive periods and then being talked down to by consultants;
- poor maintenance in operating theatres, potentially putting patients in danger;
- patients often being moved repeatedly between wards without being told why;
- staff working for 12 days in a row without a break;
- blood being taken from patients in full view of the rest of the ward; and
- low levels of clinical cover - especially out of hours.”

1.21pm: Mr Hunt said there were some failings at all the 14 trusts reviewed. However he said 11 would be placed in special measure. The 11 are: Burton FT, Tameside FT, North Cumbria Trust, North Lincolnshire and Goole FT, United Lincolnshire Trust, Sherwood Forest Foundation Trust, East Lancashire Trust, Basildon and Thurrock FT, George Eliot Trust, Medway FT, and Bucks Hospital Trust.

1.12pm: Jeremy Hunt has begun his statement on the Keogh mortality review. He says: “This government is deeply proud of our NHS.… The last government also failed to prioritise compassionate care. Targets mattered more than people.”

He says some of the 14 trusts have improved but some have not sufficiently. Eleven of the 14 will be placed in “special measures” by the NHS Trust Development Authority or Monitor.

12.39am: Guardian political editor Patrick Wintour has been reporting about a letter from Baroness Barbara Young, former CQC chair, stating that she was not pressured by the last Labour government to cover up care failings.

12.31pm: Speaking at health questions, Jeremy Hunt has reiterated the importance of “accountability” in relation to the mortality review. There is some expectation board members will lose jobs over the investigations. Other indications are that trusts will be subject to further reviews and performance management, with the possibility of action against board in future. Mr Hunt said: “How people are held accountable, because that’s what has been missing and has to be put right”.

12.04pm: HSJ reporter Sarah Calkin tweets: “Keogh’s other review (urgent and emergency care) will report in Autumn, including a review of 111 - Hunt tells HoC”

11.53am: Jeremy Hunt was also pressed on whether the government would set minimum safe staffing levels. He said Robert Francis had told Nursing Times he did not want minimum levels to be set.

11.51am: At Commons health questions Jeremy Hunt is being pressed on nursing staff cuts, in relation to Keogh mortality review, by Andy Burnham. Jeremy Hunt says there was “inaction by Labour” in relation to the trusts with high mortality ratios.

11.45am: Ben Clover is leading our coverage on the Keogh review today - follow him on Twitter for updates.

11.45am: We have published a story on the leaks of the Keogh review.

11.43am: The BBC’s Norman Smith tweets: “No 10 reject expected criticism in Keogh report over staffing levels - 8000 more clinical staff now employed in NHS.

“No 10 say 5500 more doctors,1300 more midwives and 1000 health visitors in NHS - but not provide figures for nurse jobs lost

“No 10 reject claims political blame game over Keogh risks undermining confidence in NHS.”Public has a right to know”“

11.12am: There have been some fairly extensive leaks of quotes from the overarching Keogh report in the past half hour. HSJ editor Alastair McLellan has tweeted much of the information.

10.51am: In an opinion piece for the Daily Telegraph former Number 10 adviser Sean Worth says Labour must bear the blame for the shameful decline of the NHS

A Daily Telegraph investigation has found taxpayers are being charged up to 40 times the usual cost for common over-the-counter products being prescribed by NHS doctors.

The paper says: “The NHS is currently paying up to £89.50 for cod-liver oil capsules — identical versions of which can be bought on the high street for about £3.50. Taxpayers are also being hit with inflated costs for vitamin E, evening primrose oil and other over-the-counter products.”


10.49am: The Daily Telegraph carries a front page story on the abolition of the Liverpool Care Pathway under the headline Callous: the verdict on NHS care for the dying

It says: “Too many patients have been left facing the desperate and “terrifying prospect” of spending their final hours thirsty, with nurses even shouting at families who tried to give their loved ones water, the review led by Baroness Julia Neuberger found”.

The paper also reports a group of Conservative MPs have demanded that Andy Burnham, the shadow health secretary, resign ahead of the publication of the Keogh review.

He was previously the health secretary until 2010. Official figures released in Parliament claimed that Labour ministers were sent about 1,500 notifications, mostly from patients, about problems at 14 NHS trusts that are now under scrutiny.


10.47am: The Telegraph website reports this morning that the Keogh review will link some failings to low nurse staffing levels. It indicates he will call for a review of staffing levels. The report is not confirmed.

10.42am: The Guardian today reports that “Keogh’s inquiry has uncovered poor care, poor leadership or both at 11 of the 14 trusts with high mortality rates”.

It reports that all of the five non-foundation trusts on the list will receive visits from a “team of regulators at the NHS Trust Development Authority.”

The NTDA can still be formally directed by the Department of Health in a way Monitor, that regulates the other nine trusts cannot.

10.28am: There is another interesting take on the review and use of mortality ratios on this blog.

10.24am: There is detailed information on the Keogh mortality ratio review including how it began, the process, the trusts involved, and key lines of enquiry at each trust on the NHS Choices website.

10.10am: Sir Richard Thompson, president of the Royal College of Physicians, has published a statement ahead of the mortality review publication.

He said: “It is clear that parts of the system must change to better meet patients’ needs.

“As we highlighted in our Autumn 2012 report, Hospitals on the edge?, the NHS is struggling to cope with increasing pressures on acute services, patients with increasingly complex needs, and a breakdown of out-of-hours care.

“Patients deserve high quality care that meets all of their needs. To achieve this, both the system and patient care pathways must be designed around patients’ needs. Current services no longer meet the needs of patients; we are trying to fit around outdated systems. Patients’ demands have changed and so our hospital services must change.

“The RCP continues to push for a seven day health service. We encourage transparency across the NHS, as well as the use of audit data and accreditation to drive up quality.”

10.05am: The BBC website has an opinion piece by Roger Taylor, one of the founders of Dr Foster Intelligence, which developed and publicised hospital standardised mortality ratios.

He says: “The change that is happening to the NHS is not deterioration in the quality of care. It is recognition that poor quality care is no longer acceptable.”

9.59am: Ahead of the reports, HSJ has published a free to access brief guide to mortality ratios. These figures have been used prominently by national media in recent days to suggest the scale of quality problems at various hospitals.

9.50am: Reports on the 14 trusts which have been reviewed under the initiative are due to be published around 12.30am-1pm. They will detail the findings at each trust. It is thought an overarching report will also be published, with details of how reviews were carried out, and any national findings / lessons learned.

8:50am: Today we will covering and analysing the mortality review carried out by NHS medical director Sir Bruce Keogh on 14 trusts.

Coverage will be free for registered users. Go to www.hsj.uk/register to find out how to sign up. 

8:15am: This week HSJ will be celebrating women in healthcare, focusing on female leaders and featuring a list of 50 most inspirational women in the sector. Click here every day for the latest opinion, Q&As and more.

Readers' comments (5)

  • Burnham can look after himself but the audacity of a government in power for over three years to blame the present on the last Labour administration fills me with perverse admiration. Lynton Crosby's DNA will be found in the oozing bile!

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  • FACT. Both Chairman and Chief Executive were removed from United Lincolnshire after raising concerns of targets being prioritised over quality.

    FACT. The SHA, led by Barbara Hakin, audited the hospital and judged the basic care to be safe. She is the subject of an extremely slow GMC investigation for her actions.

    FACT. Poor care in the Lincolnshire Trust has been reported today in the report presented to Parliament.

    Why is she still tolerated in the Department of Health? How can she have any credibility?

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  • Apart from a general nod towards all Trust guarding against isolation, I can't see mention of reconfiguration / centralisation of services to address quality concerns in any of these 14 most troubled trusts, even the small ones - it's all about running their hospitals better.

    If momentum for reconfiguration isn't generated from this process it will never get off the ground. Local populations will never wear losing services because 'we can't afford them'. It's got to be argued from quality and patient safety, surely?

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  • The moribund nature of the commissioning system is truly exposed by this saga, and it is probably time to close the internal market. What is the point of a PCT/CCG if (a) its contract monitoring is not allowed politically to tackle the fundamentals of unnecessary deaths, poor clinical care, and clinical negligence and (b) when something goes wrong, the local commissioner is never held to account by the media or external reviewers - ie there is no expectation among patients and rev that the commissioner will have intervened. If local commissioning is not to be given teeth, better to scrap it and save a fortune, some of which could be ploughed into 24/7 working.

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  • Ms Bailey "time for managers to lead is over "----I think not Real managerial leadership should now come to the fore !!

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