Review into the quality of care and treatment provided by 14 hospital trusts in England

Document type
Keogh, Bruce
Date of publication
16 July 2013
Health Services
Social welfare
Material type

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This review looked at the quality of the care and treatment provided by 14 trusts identified as having higher than average death rates in the two years before it kicked off in February 2013. The review has revealed problems in care that had not been exposed before. While the report said immediate safety issues found were dealt with straight away, it also called for co-ordinated efforts to improve care and accountability in the longer term. Key findings from the review included:

  • Understanding that concepts such as excess deaths and avoidable deaths are more complex than analysing a single-level summary death rate indicator (two widely used death rate indicators were the basis of results of this review).
  • There are many different causes of high death rates and there is no “magic” solution.
  • Death rates in NHS hospitals had been falling over the past 10 years and the rate of improvement in the 14 hospitals under review was similar to other NHS hospitals.
  • Factors often claimed to be associated with higher death rates (such as access to funding and poor health of the local population) were not found to be statistically associated with the results of these hospitals.
  • More than 90% of deaths in hospital happen when patients are admitted in an emergency rather than for a planned procedure. The review says it is therefore not surprising that all of the 14 hospital trusts had higher deaths in urgent and emergency care, and only one trust (Tameside General Hospital) had high death rates for elective procedures.
  • Understanding the causes of higher death rates is said not to be about finding a “rogue surgeon” or problems occurring in a single specialty area. The review says it is more likely to be a combination of problems that all hospitals in the NHS experience, such as busy A&E departments and wards, treatment of the elderly, and the need to recruit and keep excellent staff.




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