The Keogh Review

Following Robert Francis QC's report into the Mid-Staffordshire NHS Foundation Trust, in February 2013 the Health Secretary asked Professor Sir Bruce Keogh, Medical Director of NHS England, to conduct Following Robert Francis QC's report into the Mid-Staffordshire NHS Foundation Trust, in February 2013 the Health Secretary asked Professor Sir Bruce Keogh, Medical Director of NHS England, to conduct a review into hospitals with persistently high mortality rates.

Professor Keogh selected 14 hospitals on the basis of the fact that they had higher than expected mortality rates for the two preceding years considered against either the Summary Hospital-Level Mortality Index ('SHMI') or Hospital Standardised Mortality Ratio ('HSMR') index.

The review report, published earlier in July, found significant scope for improvement in each of the Trusts with each needing to address an urgent set of actions to raise standards of care. The overall aim of the review was to identify factors which contributed to avoidable deaths and ways in which those deaths could be avoided.

The report highlights a number of common themes or barriers to delivering high quality care which are relevant to the wider NHS:

• The limited understanding of how important and how simple it can be to genuinely listen to the views of patients and staff and engage them in how to improve services;


• The capability of hospital boards and leadership to use data to drive quality improvement (which is compounded by difficulties accessing data, which is held in a fragmented way across the system);


• The complexity of using and interpreting aggregate measures of mortality, including HSMR and SHMI. The report concludes that "it is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths";


• The fact that some hospital trusts are operating in relative isolation (whether geographical, professional or academic), often leading to an over-reliance on locums and agency staff;


• The lack of value and support being given to frontline clinicians, particularly junior nurses and doctors. The report concludes that " their energy must be tapped not sapped";


• The imbalance that exists around the use of data "simply for reassurance, rather than the forensic, sometimes uncomfortable, pursuit of improvement".

In addition, the report set out eight 'Ambitions' for improvement within two years. The ambitions include demonstrable progress towards reducing avoidable deaths in hospitals, involving patients and junior clinicians to a greater extent and ensuring that data is used transparently in order to foster improvement in services.

It is clear from the review that Professor Keogh has serious concerns about how patient and staff engagement feed into service improvement and about how data can better be used to improve services rather than lay blame. Given the findings of the Francis Inquiry, it would be naïve to think that the concerns highlighted by the review are confined to the 14 Trusts which were part of it. Keogh's ambitions are lofty and it will be interesting to see to what extent those ambitions are achieved.

The final report can be downloaded here.