The Keogh review has found “lack of sufficient implementation of clinical strategies and effective clinical leadership” as one of the main areas of concern at Northern Lincolnshire and Goole Hospitals Foundation Trust.

It points out the absence of effective clinical leadership and inadequate involvement of medical staff in redesigning services to address the high mortality levels, particularly in Grimsby.

The trust has three hospital sites, the Diana, Princess of Wales Hospital in Grimsby, Goole and District Hospital, and Scunthorpe General Hospital.

The review, carried out by NHS England medical director Professor Sir Bruce Keogh, examines the higher than expected mortality rates at 14 NHS trusts.

It reports that “inadequate progress is being made to improve the quality of services utilising effective clinical leadership, especially in relation to the provision of stroke care”.

The review has asked the trust to work with the CCG to urgently address the provision of stroke services out of hours.

It also 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”.

However, the review did observe a number of examples of good practice across the trust as well, including diagnostics, the midwifery service in Grimsby and the diabetes ward in Scunthorpe.

Some of the key recommendations mentioned in the review include:

  • Develop a clinically led approach to managing the acute medical pathway in conjunction with staff and stakeholders
  • The number of patient moves and number of outliers should be monitored as an indicator of performance and clinical quality.
  • Embed junior doctor involvement in quality improvement and mortality focused project
  • Perform a trust wide review of the application of the national definitions and reporting of mixed sex accommodation breaches.
  • Ensure effective communication with the nursing workforce regarding strategic direction for nursing

Liz Scott, medical director of the trust, said: “We very much welcome this report and value the Keogh team’s support and advice. They have been fair in highlighting examples of good practice as well as improvements that need to be made.

“There is still more work to do but we are confident we will continue to bring our mortality ratios down further.”

Chief executive Karen Jackson added: “There are no surprises in the final report. It reinforces what we already know and are working on, and reassures us that we are addressing the right issues. The majority of the recommended actions are already being implemented. However, we need to make more progress, faster.

“Patient safety and quality of care is always our top priority. People can be reassured that we are committed to putting our patients, their safety and wellbeing at the very heart of everything we do.”

The trust recorded a £2m surplus against a turnover of £318m in 2012-13 and has an overall HSMR of 114 for the period January 2012 to December 2012.

Peter Melton, accountable officer for North East Lincolnshire Clinical Commissioning Group, said:  “The people of Northern Lincolnshire should have high quality health services that compare with the very best in the country and following the CCGs’ previous report into mortality rates in Northern Lincolnshire a lot of work has been done by everyone concerned to improve the quality of care.

“As CCGs it is our job to continue to drive these improvements in care.”

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