Bringing the Keogh 14 in from the cold

It is lonely at the bottom. That is the message from Sir Bruce Keogh’s review of the 14 trusts with the poorest mortality figures.

Reading his concise and perceptive report, a picture emerges of organisations cut off from the best practice that flows through the blood stream of the most successful trusts.

‘The sensible conclusion that Sir Bruce reaches is that “these trusts will need considerable and sustained external support” to improve’

The Keogh review trusts are places which “tend not to be well linked to professional networks and other centres of knowledge”, and where “attracting top managers is a long-standing challenge”. They are the trusts at which the “capability of medical directors and/or directors of nursing” is questionable and where “boards too easily accept the assurances they were receiving”, while “not really listening to contradictory evidence.”

• Full coverage of the Keogh review

Not another Mid Staffs

These trusts “manage” complaints rather than seek patient feedback and employ staff who feel “uncomfortable raising issues with senior management”. They do not know how many nurses work on their wards − sometimes risking the quality of care − and, as a result, deal badly with “complex deteriorating patients”.

This − rather than financial pressures or rising demand − is what marks these trusts out as unusual.

The sensible conclusion that Sir Bruce reaches is that “these trusts will need considerable and sustained external support” to improve. There may yet be changes at the top of these trusts − and they may sometimes be warranted − but it is to be hoped in most cases their leaders are given enough breathing space to make use of that support.

None of these trusts are “another Mid Staffs”. Given the deep seated problems many of them face, these organisations need time to come in from the cold, not to be buried by an avalanche of constant criticism.