17th July 2013 

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Through the Keogh      
News and Comment from Roy Lilley

I think yesterday was the hottest day of the year.  It was certainly a day to sweat.  Particularly if you happened to be one of the 14 hospitals, the subject of the Keogh Review.  Special measures, resignations, early retirements the whole nine yards.


Bruce Keogh's Review is the best NHS report I have ever read... and I've read a few since 1974.  I want you to read it, too.  Please.  Cuppa-builders and a packet of Hobnobs.  Sixty one pages of common-sense, truth, courtesy, concise, clear analysis.  Doable fixes and ambition.  (If your Trust is involved, go to page 35 for the summary of your place).  On the way a few Holy Cows are slaughtered, not least:


"... the complexity of using and interpreting aggregate measures of mortality, including HSMR and SHMI. The fact that the use of these two different measures of mortality to determine which trusts to review generated two completely different lists of outlier trusts illustrates this point. However tempting it may be, it is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths."




"... It is important to understand that mortality in all NHS hospitals has been falling over the last decade: overall mortality has fallen by about 30% and the improvement is even greater when the increasing complexity of patients being treated is taken into account."


Keogh is internationally famous, highly regarded and has shown everyone how to conduct a review that is accepted by those reviewed, understood by the people who need to read it and reassuring for the staff who work in the organisations.  It is a work of genius.


Whilst these 14 Trusts have been collecting barnacles we have forked out millions to the CQC and Monitor to do keep us safe.  Keogh has done it in six months for a fraction of their costs.  It is not just eleven Trusts that should be in special measures, it is the regulators, too.  And, for my money, you can add to the pile the GMC, NMC, Confed, Royal Colleges and anyone else that has ever tried to tell us how to run the NHS.


Keogh's report has ambition.  Eight actually: a new national indicator on avoidable deaths; better commissioning; real-time patient feedback 'beyond the F&F Test';  putting a boot in the behind of the CQC to buck its ideas up; networking to share good practice; involving docs and nurses in mortality and morbidity meetings; happy and engaged staff.


The common causes of difficulty the 14 faced are like the blue-stripe in the NHS tooth-paste.  Busy A&Es, too many elderly admissions, staffing levels (Seven of the 14 trusts investigated by the Review have between them cut 1,117 nursing jobs since the Election), dysfunctional Boards.  Is there anything there you hadn't heard of, didn't know about?


Where did I read; 'Fund the front-line properly, protect it fiercely, make it fun to work there and your problems will disappear'! 


Is there a Board reading this Report who will not want to be meeting on Friday to be assured that but for the grace of god and a coding error (that could have tipped them into the HSMR category of the 14), go they.  If you are working for a Trust that isn't having an extra Board meeting on Friday - look for another job.


This excellent report and the data sets that support it it are a template for quality assurance and could be used in-house or even by a CCG to inspect what they buy and where they buy it from.  This report shows us how to inspect with rigour and respect and gives us a new 'quality question' for the NHS to answer; do you have a problem looking at your Trust 'through the Keogh?'   


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