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Q&A: What is the Keogh Review and what did they find?

Feeling confused? Here’s the Keogh Review at a glance

Q: What is the Keogh Review?

A: Sir Bruce Keogh, Medical Director of the NHS in England, has led investigations at 14 trusts with higher than expected mortality rates. An inspection team visited each of the trusts, which have had high mortality rates for the last two years

Q. What trusts were involved?

A. The 14 hospital trusts are: Basildon and Thurrock in Essex; United Lincolnshire; Blackpool; The Dudley Group, West Midlands; George Eliot, Warwickshire; Northern Lincolnshire and Goole; Tameside, Greater Manchester; Sherwood Forest, Nottinghamshire; Colchester, Essex; Medway, Kent; Burton, Staffordshire; North Cumbria; East Lancashire; and Buckinghamshire Healthcare

Q. Who ordered the review?

A. Prime minister David Cameron commissioned the report in February after Robert Francis QC’s public inquiry report into the Stafford scandal exposed appalling lapses in both care of patients and the regulation of hospitals

Q: What did the review find?

A. The Keogh review found frequent examples of inadequate numbers of nursing staff. All 14 trusts are now carrying out “urgent reviews of safe staffing levels”.

Eleven of the 14 hospital providers investigated because of high mortality ratios have been placed in “special measures”, health secretary Jeremy Hunt has announced.

After reviewing each of the trusts, the teams found that having less nursing staff was linked to higher in-patient mortality rates.

Q: Did the report think that the trusts should be held responsible for the  deaths?

A: Not necessarily. Over the weekend, newspapers reported that the NHS was responsible for 13,000 deaths since 2005, but Sir Bruce Keogh disagreed.

Instead he said in his review that it is “clinically meaningless and academically reckless” to associate statistics with the actual number of deaths.

Q: What were some key suggestions for improvement?

A: The Keogh review suggested that:

  • a) Trusts more closely monitor bed management and patient flow, so as to decrease the risks that come with low staff to in-patient ratios.
  • b) He also made the point that trusts need to work to better understand patients’ views.
  • c) There are also plans to address safety and quality changes in each of the trusts.

Read all our Keogh Review content today




Readers' comments (14)

  • Its all very well 'more closely monitoring staffing' but they need to do something to encourage more 'would be' nurses into the industry. There clearly isn't enough to go round when they try to draft more staff in to fill the gaps!

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  • It's all very well saying there isn't enough nurses, which I acknowledge there isn't, but when hospitals have to save money who are the first to go. And what do you then get, your not answering buzzers quickly enough, etc,etc.

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  • There are numerically more nurses than any other group, so more money is saved by keeping the numbers lower than necessary to maintain good standards. This will continue because nurses, on the whole, do not have the energy, time, wherewithal to monitor standards and identify what they should be and why they are not being met. Frontline nurses tend to get the blame if things go wrong. The senior managers get a good payoff if they have to leave. It's all topsy turvey. The senior managers should serve the nurses to help them serve the patients, instead of producing dodgy statistics.

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  • There are plenty of qualified nurses and midwives in bankrupt European countries who are willing to work here for a lower grade than they deserve.

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  • don't the logistics of nursing also need looking at to ensure nurses are doing what they are paid for rather than all of the extraneous jobs which are dumped on them.

    might it help to extend the number of working hours a week to 38 or more to create extra nursing hours which would be renumerated instead of the large numbers of nurses finding themselves having to do this unoficially without pay and often without breaks. it could help to reduce stress levels.

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  • Government cuts are wholly responsible for the current crisis in standards of care. Nurses/doctors are being given double workload to perform within the same working hours. Target driven strategies whilst cutting staffing levels destroys the fundamental reason for standards of care, which inevitably suffers. The general public are often unaware of the cause & effects of statistical politics imposed on Trusts & frontline staff are ultimately blamed.

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  • After reviewing each of the trusts, the teams found 'that having less nursing staff was linked to higher in-patient mortality rates'. - I thought this had been in the nursing literature
    for years?

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  • As a new qualified nurse Jan 12 I began to work on an elective orthopaedic ward. After six months I left. Why? Because I felt my hard earned registration was being risked daily by the endemic attitude and expectations to work at critically low levels of staff. Should the newbie complain? Pointless. Established staff at any level will soon remind you that this is it, 'welcome to nursing' is is just how it is, etc etc.

    One particular shift was the last straw, on a blistering hot day, the old nightingale ward ill equipped for modern nursing, tested my very core. The handover at the beginning of the 13 hr day already suggested this was going to be a tough one, just two nurses, and one nursing assistant...24 patients...6 had major operations the afternoon previous, another 6 due to go have major operations that day, new admissions to sort, plus discharges to arrange. The na despaired that she was not going to manage - how could she possibly? Myself and the other nurse despaired, we were going to have to manage, I hoped that the day played out better than it looked on paper.

    But it did not.

    One patient was particularly poorly, my immediate attention was needed. The drugs ...the I'V's...the admissions...the paperwork...the dressing changes...the washes...the beds...the friendly chat...all important, all have their place in my day, all need to be dealt with in order, on time. My poorly patient...the major patients one by one return from theatre. The checklist. The PCAs, the wound check, the IV's. The pain management. The discharges...they want to go home. The advice. The wound check. The TTO's. The drug round, my poorly patient....
    Pressure area care, paperwork, diabetics, dietitians, dialogue, handovers, inputting, charting, logging, updating, physiotherapy, occupational therapists, who is in pain? The buzzers, the needs, the wants, the nightingale ward...the length..patient one half a mile from patient twelve..up, down, poorly patient. Is there something that can give? Is there one thing I can not do today? No. It all needs doing. More than one poorly patient...two, oh three, crash team. Twice. Shift ended. Handed over. Three hours later. Still there. Paperwork. My poorly patient. Died.

    In reflection ( I hate reflections ) could I have done it different. No. Could it have been done better. Only if it had been different. Did I ask for help. Oh yes. Did it come? No. Did I submit an incident report form on the near miss, the lack of support and dangerous staffing level. On yes. Did it make a difference? No. Because this is nursing, this is what it's like..why should the newbie complain when the established staff have been putting up with it for years? On my induction we was told quite proudly that our directorate was the only one that finished the financial year in the black to the tune of two hundred grand. At what cost? So that the call for more staff, or emergency agency staff can fall on deaf ears, to ensure the financial pat on the back is firmly in place for another year?

    Me? Gone way was I going to be that nurse that tells the newly qualified 'welcome to nursing this is how it is '

    My argument was, when is all goes wrong, there is no time machine to go back, to say to the coroner .,come back...see what I did that day..see how hard I me when in that 13 hr shift that I had spare time? Whose fault will it be? How can you possibly say in a 13 hr shift I didn't have time?..and be believed.

    This was one shift, not an unusual shift, not a different shift, just one. The one that made me stop and think. Is this the nursing I want to do? Is this what I want my patients to remember of me? Is this what I want to be associated with?

    Yes there is an acute lack of staff, but it goes much deeper than that. In teaching do they make do and have one teacher running between two classes? No. If someone doesn't show up, agency are called. Immediately.

    Until the culture of make do and manage ceases to exist within nursing, nothing will change.

    I want to be a good nurse, an efficient nurse, a proud to do my job nurse. Difficult days? Of course, pushed to my limit days? Of course. But never the nurse that everyone wishes had more time, wasn't pushed beyond the limit, didn't have time to just give you five minutes, never the nurse that finishes her day three hours after her day finished simply because she didn't have time.

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  • The above commenter puts this so well and what a good point, saying that this would not be accepted anywhere but nursing. I have been a nurse for 28 years and I despair, having seen change after pointless change and now cuts which have a huge impact on patient care. In mental health we are busier than we have ever been, the austerity measures are having a huge human cost. But we have fewer resources, and management who are quick to blame nurses when things go wrong. I would give it all up today if I had the option.

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  • Anonymous | 20-Jul-2013 9:31 am

    EXCELLENT COMMENT - which should be shouted - no apologies for doing so!

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  • michael stone

    Anonymous | 20-Jul-2013 9:31 am

    This is exactly the sort of stuff that should be sent to Hunt, and published in the Mail and the Telegraph ! Until nurses explain the problems clearly, most of Joe Public will remain misled and hoodwinked.

    However, I opened an e-mail from a consultant contact an hour ago, in reply to something I'd sent to him yesterday, and he mentioned a meeting he has been invited to, that I might like to try and get invited to: further details revealed that this meeting is 'Chatham House Rules'. CHR means (as I understand it) you can't say who was there, and you can't say what was said - not, in my opinion, a good fit with this 'openness and transparency is the new spirit within the NHS' theme !

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  • If Hunt is so involved with nursing he should be regularly reading the NT and other NHS and prof. journals and the comments.

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  • Anonymous | 20-Jul-2013 9:31 am

    This comment completely backs up recent discussions over several articles in NT. That is addressing the issues of effective challenging whilst nurses are training, and educating the current RNs on this crucial skill. This nurse is newly qualified and already has given up. She/he has not been properly equipped to challenge the status quo.
    Would other professions accept these conditions? No. There is another article in NT online in which nursing is described as 'a low status profession'.
    I disagree profoundly with the comment stating that the post from anon 9.31pm should be shouted with no apologies for doing so. We should hang our heads in shame that we have allowed a situation to develop where our newly qualified nurses are so incapacitated and where the attitude of their seniors are held up as a reason for throwing in the towel.
    We can blame the government, nurse leaders, bankers and uncle tom cobbly and all. After all we've been doing it for years. It is never our fault and we never think that it is something that requires much more than just complaining about it. Learn to fight back and have the courage to do so.

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  • To Anon, 22 July 1:29 pm. I am the writer of the previous anon comment, I felt it should only be fair to rectify, I have not left nursing, nor gave up. I have left nursing on a ward however as it was in this particular area that I felt the inability to be an adequate nurse was the greatest.

    I have worked in the NHS for many years, qualifying in another area before deciding to train as a nurse in addition. However it does not matter how much previous experience one has in life or with the nhs, newly qualified is exactly that. The only difference was the experience to be able to confidently recognise right from wrong. I also feel as a 40 something that I can comment on management style, skill, effectiveness etc and have an opinion on this. Especially on how I would prefer to be led and managed myself. It was this combined with the vulnerability of being newly qualified allowed me to see the huge risks involved with the working conditions I was in, the scary part is that the typical young newly qualified does not have this experience therefore may not see the danger.

    My training was adequate, I still maintain it is a systemic problem within heirarchical societies like nhs hospitals that breed a certain managerial style and ethos - they learn from each other and are bred from within, it's just not healthy.

    I feel I have had an interesting perspective, as I was not ward based in my previous role, but was an autonomous practitioner. To then spend three years dipping into a variety of other areas getting brief glimpses of the working life of others within one trust. It was very much an insight into how the various difficulties affect people in their work and home life. I felt dreadfully sad for some situations I came across where team spirit would overthrow common sense as people would work enormous amounts of overtime and staying late etc to ensure that their areas were staffed. Giving a little bit extra is great it shows passion, but not to the levels I witnessed, and the fact that someone is willing to do it is one thing, actually allowing them to is another - but have little to no choice is worse.

    I left the ward because I didn't want to be bitter, I didn't want to be moaning all the time, I didn't want that passion for nursing being sucked from my inner core within a year. I want to be happy at work, I want to wake up wanting to go to work, I want to come home feeling satisfied from the job I have done. None of that should be too much to ask. The reason why I say that is because in my previous job there was not one single day that I didn't want to go matter how hot, stressful, busy, sad, arduous it was ..I loved it. I hoped I would love nursing just as much.

    So far I do not. But I have not gave up yet!

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