BMJ 2015;350:h744 doi: 10.1136/bmj.h744 (Published 9 February 2015)
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NEWS Hospitals put into special measures in 2013 have cut their mortality Gareth Iacobucci The BMJ
Death rates at the 11 NHS hospital trusts in England that were placed into special measures in July 2013 have fallen since the measures were introduced, a new analysis has found.
The healthcare analyst company Dr Foster, which carried out the study, said that it found a “significant reduction” in death rates when the 11 trusts were taken as a group.1 But the company said that the figures also showed “significant variation” in performance between the trusts. The 11 were placed into special measures in July 2013 after they were identified as having higher than expected death rates in a review by NHS England’s medical director, Bruce Keogh.2 The review was carried out in response to the public inquiry by Robert Francis QC into the failings at Mid Staffordshire Hospital.3
The special measures regime is overseen by England’s healthcare regulator the Care Quality Commission, with fellow regulators the NHS Trust Development Authority and Monitor in charge of implementing support packages to help hospital trusts.
Dr Foster’s analysis found that the 11 trusts showed a decline of 9.5% in mortality rates from the point they were placed in special measures to the latest available point in August 2014. In the same period there was a 3.3% fall nationally in mortality. On average, the 11 hospitals still had a higher mortality rate than the national average, but Dr Foster said that the gap had “narrowed considerably” since the measures were introduced.
The research used national hospital standardised mortality ratios and summary hospital level mortality indicators. The researchers compared mortality data from the 11 trusts placed in special measures with thousands of randomised samples from other English trusts to see how they had performed in relation to the average. Analysts said that it was difficult to know what had driven the change, as the special measures intervention was a managerial rather than a clinical one. But they suggested that changes to the trusts’ senior management and the appointment of “buddy” hospitals to provide support to struggling organisations may have contributed. They added that the variation seen between the 11 trusts was consistent with the CQC’s August 2014 report that measured improvement at the hospitals.4
The two trusts that the CQC removed from special measures immediately in August 2014—Basildon and Thurrock University Hospitals NHS Foundation Trust and George Eliot Hospital For personal use only: See rights and reprints http://www.bmj.com/permissions
NHS Trust—both exhibited strong turnarounds in mortality rates in Dr Foster’s analysis.
A similar turnaround was seen in East Lancashire Hospitals NHS Trust, which was allowed by the CQC to exit special measures with some continued support in place.
Five of the 11 trusts—Buckinghamshire Healthcare NHS Trust, North Cumbria University Hospitals NHS Trust, Northern Lincolnshire and Goole NHS Foundation Trust, Sherwood Forest Hospitals NHS Foundation Trust, and United Lincolnshire Hospitals NHS Trust—displayed what Dr Foster called “a consistent downward trend” in mortality. Two trusts—Burton Hospitals NHS Foundation Trust and Medway NHS Foundation Trust—showed no change, while one, Tameside Hospital NHS Foundation Trust, showed a rising trend.
Commenting on the findings, Roger Taylor, Dr Foster’s director of research and public affairs, said, “Our analysis gives us some hard evidence that special measures can be an effective tool for turning around NHS trusts that experience problems. “This is an intervention that has produced positive outcomes for patients.”
But he added, “The caveat is that [special measures] is pretty ill defined as an intervention, so to try to understand why it’s working and what’s working is difficult.
“It’s now up to the NHS to learn the lessons of what worked in each of the 11 trusts so that a best practice approach for special measures can be adopted.” Taylor added that the analysis also indicated that the CQC was making sensible judgments on when to remove trusts from special measures. “The ones that were allowed out of special measures first are the ones which had the clearest turnaround in mortality rate,” he said. 1 2 3 4
Dr Foster. Is “special measures” working? A review of mortality rates at the 11 trusts put into special measures. 9 Feb 2015. www.drfoster.com/updates/recent-publications/isspecial-measures-working. Kmietowicz Z. Health secretary puts 11 hospital trusts in England into special measures. BMJ 2013;347:f4602 Kmietowicz Z. Fourteen hospital trusts are to be investigated for higher than expected mortality rates. BMJ 2013;346:f960. Care Quality Commission. Special measures: one year on. A report into progress made at 11 NHS trusts that were put into special measures in July 2013. www.cqc.org.uk/sites/ default/files/20140801_special_measures_one_year_on_report_final.pdf.
Cite this as: BMJ 2015;350:h744 © BMJ Publishing Group Ltd 2015
Subscribe: http://www.bmj.com/subscribe
BMJ 2015;350:h744 doi: 10.1136/bmj.h744 (Published 9 February 2015)
Page 2 of 2
NEWS
For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
Page 1 of 2
News
NEWS Hospitals put into special measures in 2013 have cut their mortality Gareth Iacobucci The BMJ
Death rates at the 11 NHS hospital trusts in England that were placed into special measures in July 2013 have fallen since the measures were introduced, a new analysis has found.
The healthcare analyst company Dr Foster, which carried out the study, said that it found a “significant reduction” in death rates when the 11 trusts were taken as a group.1 But the company said that the figures also showed “significant variation” in performance between the trusts. The 11 were placed into special measures in July 2013 after they were identified as having higher than expected death rates in a review by NHS England’s medical director, Bruce Keogh.2 The review was carried out in response to the public inquiry by Robert Francis QC into the failings at Mid Staffordshire Hospital.3
The special measures regime is overseen by England’s healthcare regulator the Care Quality Commission, with fellow regulators the NHS Trust Development Authority and Monitor in charge of implementing support packages to help hospital trusts.
Dr Foster’s analysis found that the 11 trusts showed a decline of 9.5% in mortality rates from the point they were placed in special measures to the latest available point in August 2014. In the same period there was a 3.3% fall nationally in mortality. On average, the 11 hospitals still had a higher mortality rate than the national average, but Dr Foster said that the gap had “narrowed considerably” since the measures were introduced.
The research used national hospital standardised mortality ratios and summary hospital level mortality indicators. The researchers compared mortality data from the 11 trusts placed in special measures with thousands of randomised samples from other English trusts to see how they had performed in relation to the average. Analysts said that it was difficult to know what had driven the change, as the special measures intervention was a managerial rather than a clinical one. But they suggested that changes to the trusts’ senior management and the appointment of “buddy” hospitals to provide support to struggling organisations may have contributed. They added that the variation seen between the 11 trusts was consistent with the CQC’s August 2014 report that measured improvement at the hospitals.4
The two trusts that the CQC removed from special measures immediately in August 2014—Basildon and Thurrock University Hospitals NHS Foundation Trust and George Eliot Hospital For personal use only: See rights and reprints http://www.bmj.com/permissions
NHS Trust—both exhibited strong turnarounds in mortality rates in Dr Foster’s analysis.
A similar turnaround was seen in East Lancashire Hospitals NHS Trust, which was allowed by the CQC to exit special measures with some continued support in place.
Five of the 11 trusts—Buckinghamshire Healthcare NHS Trust, North Cumbria University Hospitals NHS Trust, Northern Lincolnshire and Goole NHS Foundation Trust, Sherwood Forest Hospitals NHS Foundation Trust, and United Lincolnshire Hospitals NHS Trust—displayed what Dr Foster called “a consistent downward trend” in mortality. Two trusts—Burton Hospitals NHS Foundation Trust and Medway NHS Foundation Trust—showed no change, while one, Tameside Hospital NHS Foundation Trust, showed a rising trend.
Commenting on the findings, Roger Taylor, Dr Foster’s director of research and public affairs, said, “Our analysis gives us some hard evidence that special measures can be an effective tool for turning around NHS trusts that experience problems. “This is an intervention that has produced positive outcomes for patients.”
But he added, “The caveat is that [special measures] is pretty ill defined as an intervention, so to try to understand why it’s working and what’s working is difficult.
“It’s now up to the NHS to learn the lessons of what worked in each of the 11 trusts so that a best practice approach for special measures can be adopted.” Taylor added that the analysis also indicated that the CQC was making sensible judgments on when to remove trusts from special measures. “The ones that were allowed out of special measures first are the ones which had the clearest turnaround in mortality rate,” he said. 1 2 3 4
Dr Foster. Is “special measures” working? A review of mortality rates at the 11 trusts put into special measures. 9 Feb 2015. www.drfoster.com/updates/recent-publications/isspecial-measures-working. Kmietowicz Z. Health secretary puts 11 hospital trusts in England into special measures. BMJ 2013;347:f4602 Kmietowicz Z. Fourteen hospital trusts are to be investigated for higher than expected mortality rates. BMJ 2013;346:f960. Care Quality Commission. Special measures: one year on. A report into progress made at 11 NHS trusts that were put into special measures in July 2013. www.cqc.org.uk/sites/ default/files/20140801_special_measures_one_year_on_report_final.pdf.
Cite this as: BMJ 2015;350:h744 © BMJ Publishing Group Ltd 2015
Subscribe: http://www.bmj.com/subscribe
BMJ 2015;350:h744 doi: 10.1136/bmj.h744 (Published 9 February 2015)
Page 2 of 2
NEWS
For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
