There is ‘hard evidence’ that the special measures regime has reduced death rates at the 11 Keogh trusts and potentially saved hundreds of lives, researchers have claimed.

According to statistical analysis by Dr Foster, a healthcare information company, there has been a significant reduction in mortality rates at the trusts since the regime was introduced in July 2013.

Bruce Keogh

Sir Bruce Keogh was asked to lead a review into 14 trusts that had higher than expected mortality rates following the Francis inquiry

The 11 trusts experienced a decline in their mortality rates of 9.5 per cent, compared to a 3.3 per cent decrease nationally, from July 2013 to August last year.

In February 2013 the prime minister asked Sir Bruce Keogh, NHS England’s medical director, to lead a review into 14 trusts that had consistently higher than expected mortality rates as part of the response to the Francis inquiry.

When the Keogh review published its findings in July 2013, care quality at 11 of the trusts was judged to be so poor that they were put in special measures.

The regime aimed to turn failing trusts around through a combination of measures including “buddying” with a stronger trust, development of an action plan, appointment of an external improvement director, and enhanced scrutiny via regular progress updates on NHS Choices. Some trusts were also subject to leadership changes.

Dr Foster’s analysis of the hospital standardised mortality ratio indicator for the Keogh trusts between April 2011 and August 2014 shows that taken as a group, a significant downward shift in mortality occurred in the second quarter of 2013, shortly after special measures was imposed.

This downward trend was faster than across the rest of the country, and Dr Foster said it had analysed thousands of randomised samples from other English trusts which demonstrated this had not happened by chance.

Roger Taylor, Dr Foster’s director of research and public affairs, said: “Based on this data… [special measures] is working.”

Mr Taylor said that potentially hundreds of patients who would otherwise have died may have survived because of the improvement across the 11 trusts. He added that the research provided “hard evidence that special measures could be an effective tool”.

However, the analysis also revealed significant variation in how much mortality rates have improved between Keogh trusts.

Basildon and Thurrock University Hospitals Foundation Trust, George Eliot Hospital Trust and East Lancashire Hospitals Trust saw the biggest improvement.

Five trusts showed a more gradual improvement: Buckinghamshire Healthcare Trust; North Cumbria University Hospitals Trust; Northern Lincolnshire and Goole Foundation Trust; Sherwood Forest Hospitals Foundation Trust; and United Lincolnshire Hospitals Trust.

Two providers, Burton Hospital Foundation Trust and Medway Foundation Trust, showed no significant change, and one, Tameside Hospital Foundation Trust had a worsening mortality rate.

Mr Taylor said it was “really hard to say” what specific elements of special measures were responsible for the improvements.

He also said the variation Dr Foster identified supported the judgments the Care Quality Commission had made about the Keogh trusts when it inspected them last year.

The first two trusts taken out of special measures – Basildon and George Eliot – showed the strongest turnaround in mortality rates, whereas the two trusts rated “inadequate” – Medway and Tameside – have had flat or worsening mortality rates.    

Commenting on the report, Edward Baker, the CQC’s deputy chief inspector of hospitals, said: “The special measures process is doing what it set out to do, and I am confident that it will lead to further improvements.”

He added: “It is also notable that there is a good correlation between the pattern of mortality rates and our inspection findings”.

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