• Fewer than one in five trusts removed from quality special measures within 12 months
  • Initial expectation was trusts would come out within 12 months
  • Ten trusts have spent two years or more in the regime
  • Mike Richards says: ”What is most important is that the right changes are made and fully embedded.”

Fewer than one in five trusts placed in special measures because of inadequate care have improved quickly enough to be removed within 12 months, as originally intended, HSJ analysis reveals.

We looked at the 27 trusts which have been placed in Care Quality Commission special measures since the regime was created in 2013, and which have had more than 12 months to improve (see full table below).

Of these, only five exited special measures within a 12-month period. All these were from the original 11 placed in the regime in 2013, as part of a review into acute trusts with persistently high mortality indicators.

Regulators guidance from 2014 states: “It is intended that the usual period of time a trust remains in special measures will be a maximum of 12 months, although this may be extended in some circumstances”. It added that an extension would “not normally exceed six months”.

The average time spent in special measures by the 20 trusts which have both entered and exited the regime is 20.5 months.

Ten trusts have spent two years or more in special measures, with Colchester Hospital University Foundation Trust having been in the longest – currently at three and half years.

Earlier this year the final of the original 11 special measures trusts came out – but in the past month two of them, United Lincolnshire and North Lincolnshire and Goole, have been placed back in.

Responding to HSJ’s analysis, the CQC’s chief inspector of hospitals, Sir Mike Richards, said: “We are clear that we will only recommend that NHS trusts should exit special measures when we find that sufficient and sustainable improvements have been made to the quality of care they provide, regardless of how long or short they may have been in the regime.

“While trusts are placed in special measures for a 12-month period to begin with, this can be extended if further support is needed. What is most important is that the right changes are made and fully embedded to benefit patients.”

Initial guidance on special measures said it could be extended for trusts if regulators were not “confident” that the measures already in place would deliver required improvements.

In October 2015 an addendum was added to the special measures guide which said that if sufficient improvement had not been made within 18 months this will trigger “urgent and intensified consideration of the provider’s short and long-term improvement plans” and trusts may have to remain in special measures while “efforts to achieve long-term viability are undertaken”. This could include service reconfiguration, management support, merger or acquisition or whole system intervention in the form of a success regime.

In July last year, Sir Mike Richards, CQC’s chief inspector of hospitals said that he could not “recommend a further extension to special measures” for Colchester Hospital, the trust which has spent longest in the regime. He recommended a partnership agreement with Ipswich Hospital Trust to help find a “solution”. The two now a share a chief executive and are building a business case for a long-term partnership, which it hopes to conclude in July.

A spokesman for Colchester said that a further full CQC inspection was scheduled for the end of July this year, and was “welcomed” by the trust.

Of the other nine of the ten trusts that have remained in special measures for more than two years, North Cumbria University Hospitals FT is part of a success regime, Medway FT has a formalised buddying arrangement with Guys’ and St Thomas’ FT and the other seven either have been assigned a formal support director from the TDA or NHS Improvement or had a significant change in the executive team.

Trust nameTime spent in special measures (months)
Colchester Hospital University FT 41 (not exited yet)
North Cumbria University Hospitals FT 32.5
Medway FT 31
East Kent Hospitals University FT 29
Burton Hospitals NHS Foundation Trust 27
Sherwood Forest Hospitals NHS Foundation Trust 27
Barking, Havering and Redbridge NHS Trust 27
Tameside Hospital NHS Foundation Trust 25
Barts Health NHS Trust 25
Wye Valley NHS Trust 24
The Queen Elizabeth Hospital King’s Lynn FT 21
Norfolk and Suffolk Mental Health FT 20.5
United Lincolnshire Hospitals Trust 20, re-entered April 2017
West Hertfordshire hospitals trust 20 (not exited yet)
East Sussex Healthcare trust 20 (not exited yet)
Hinchingbrooke Health Care Trust 19
University Hospitals of Morecambe Bay FT 17
London Ambulance Service 17 (not exited yet)
Heatherwood and Wexham Park Hospitals NHS Foundation Trust (now dissolved - exited SM on acquisition by Frimley Park – now part of Frimley Health) 16
Cambridge University Hospitals FT 16
Worcester Acute Hospitals Trust 16 (not exited yet)
Walsall Healthcare Trust 15 (not exited yet)
Northern Lincolnshire and Goole FT 12, then re-entered in April 2017
East Lancashire Hospitals NHS Trust 12
George Eliot Hospital NHS Trust 12
Basildon and Thurrock University Hospitals NHS Foundation Trust 11
Buckinghamshire Healthcare NHS Trust 11
Brighton and Sussex University Hospitals Trust 8 (not exited yet)
South East Coast Ambulance Service FT 7 (not exited yet)
The Princess Alexandra Hospital Trust 6 (not exited yet)
St George’s University Hospital FT 5 (not exited yet)
Isle of Wight Trust Less than a month (not yet exited)
Kettering General Hospital Trust Less than a month (not yet exited)