A majority of the trusts placed into special measures following Keogh review inspections have expressed concern about the costs of improving care, even if most have backed the additional scrutiny they have received, according to HSJ analysis.

HSJ examined board papers at the 12 organisations taken into special measures following NHS England medical director Sir Bruce Keogh’s review of acute organisations with high mortality rates, and spoke with leading figures at many.

Our examination shows that all now have action plans in place but most have also flagged concern about the cost of implementing changes.

A report by finance director Tom Travers for Buckinghamshire Healthcare Trust’s September board meeting states: “There is a finite level of resource in the health economy as a whole… and the action plan following the Keogh review of quality is likely to result in additional cost pressure.”

Tameside Hospital Foundation Trust reported a deficit of £1.8m in the year to date at the end of September. A report by finance director Barbara Herring for the trust’s October board meeting states: “Unplanned for and unfunded costs associated with external reviews requested by Monitor and the Keogh and other reviews…totalled £377,000 that month and £728,000 in the year to date.”

One trust chief executive told HSJ: “We’ve had no additional financial support as of yet. We’ve had to make certain decisions [which lead to the risk of] additional staff and we’ve made some quite brave decisions when looking at additional doctors and nurses.”

Medway Foundation Trust has filled 19 of the 25 consultant vacancies it had earlier in the year. The trust agreed with the Keogh panel that it would begin to take action on this recommendation from June onwards.

However, several other trusts were concerned negative publicity surrounding the Keogh review had dissuaded clinicians from working at their trust. A number of the Keogh trusts reported high spending on agency staff to fill the gaps where they have been unable to recruit permanent staff.

George Eliot Hospital Trust chief executive Kevin McGee said he backed the Keogh recommendations which call for more cover overnight and on weekends because he believed they had given his trust a head start in moving to greater seven day working. “There’s some really fundamental things going on within the organisation but it’s stuff that most small to medium district general hospitals are going to have to face over the next 18 months to two years,” he said.

“Fundamentally it’s how do you move a small district general hospital towards seven day, 24 hour working and how you get the resources and the capacity to be able to deal with that? So the stuff we’re dealing with now I think we’re facing in advance of those other hospitals and the Keogh review has given us some levers to deal with that.”

Another trust’s chief executive said: “It’s certainly the most rigorous process that we’ve ever been through as an organisation but given that this is now being rolled out as part of the Care Quality Commission’s regulation process going forward it feels like we’ve got a head start on those organisations who won’t start work on that process for another year or so.”

The chief executive of a further trust said: “Some themes came out about the organisation that we wouldn’t have picked up on if we hadn’t been through the review.”