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Quarter of NHS trusts 'high risk'
More than a quarter of NHS trusts have been identified as high risk and may not be offering safe, good-quality care to patients, a new report shows.
Analysis by the Care Quality Commission (CQC) regulator found 44 trusts with the most serious level of concern, including higher than expected death rates across their hospitals.
Some trusts were flagged for incidents resulting in harm to patients while others scored low on staff or patient satisfaction.
Several came to attention due to whistleblowing staff while others had a higher than expected death rate among patients who should be low risk.
A total of 161 acute trusts across England were examined by the CQC against more than 150 indicators.
The report will act as a screening tool to identify which trusts need the most rapid CQC inspections and where inspectors need to focus their attention.
All 161 trusts were divided into six bands, with band 1 being the highest risk and band 6 the lowest.
There were 44 trusts in the two bands with the highest risk, with 24 trusts in the highest possible band 1.
They include hospitals already under the spotlight after investigations by NHS medical director Professor Sir Bruce Keogh.
Some of these trusts are already in special measures, including Basildon and Thurrock University Hospitals NHS Foundation Trust , Buckinghamshire Healthcare NHS Trust, Medway NHS Foundation Trust, North Cumbria University Hospitals NHS Trust and Tameside Hospital NHS Foundation Trust.
Alder Hey Children's NHS Foundation Trust in Liverpool has been identified as potentially high risk and sits in band 1. CQC inspectors working under a previous inspection regime said earlier this year the trust was meeting essential NHS standards.
Among five risks identified in the new collection of data, three were regarded as "elevated risks" and related to whistleblowing, the quality of data submitted by the trust and staff concerns over managers.
Leeds Teaching Hospitals NHS Trust, which runs Leeds General Infirmary, also passed essential standards last year and is listed in band 1. Concerns there include whistleblowing, cases of the bug Clostridium difficile and serious concerns over education.
South London Healthcare NHS Trust, which has now been dissolved, scored one of the highest possible risks, according to the data. The three hospitals it ran are now under the care of different trusts.
Some 17 risks were identified there, including seven that were regarded as "elevated". These included whistleblowing concerns from members of staff and the number of patient safety incidents resulting in harm to patients.
High levels of risk were also identified at Croydon Health Services NHS Trust, mostly focused on patient satisfaction.
At North Cumbria, 13 risks were identified, including 10 that were elevated These included "never events" of incidents that should never happen in NHS hospitals, higher than expected death rates and issues over the time patients waited for treatment.
High ratings were also noted at Basildon and Thurrock, and Barking, Havering and Redbridge University Hospitals NHS Trust.
At Basildon, there were 14 risks, including seven elevated risks. These included the number of patient safety incidents that were harmful to patients, higher than expected death rates and potential under-reporting of problems.
At Barking, 13 risks were identified, of which seven were elevated. These included A&E waiting times, inpatient death rates and issues around groin surgery and hip replacements.
The CQC is using the data - called intelligent monitoring - to inform its new inspection regime of all NHS trusts by December 2015.
Following these detailed inspections, t rusts will be given Ofsted-style school ratings of "outstanding", "good", "requires improvement" and "inadequate".
The CQC's chief inspector of hospitals, Professor Sir Mike Richards, said: "As a doctor, I liken intelligent monitoring to a screening test; our inspection combined with intelligent monitoring provides the diagnosis, following which we make a judgment, which will in turn lead to action.
"Our intelligent monitoring helps to give us a good picture of risk within trusts, showing us where we need to focus our inspections.
"We aim to publish the results at regular intervals. They will provide the basis for constant contact with NHS hospitals and other NHS organisations, and may lead to inspections in response to particular issues."
Dr Jennifer Dixon, chief executive of the Health Foundation and CQC board member, said: "It makes sense to use the wealth of routinely available data in the NHS to try to spot patterns which might identify or predict poor-quality care for patients.
"The intelligent monitoring tool can never by itself be a crystal ball, but it is a great start and will surely develop over time."
The CQC has said the latest information is not a final judgment, but will be used as a valuable tool to prioritise which trusts to inspect earlier on.
Not all 150 indicators are applicable to every trust.
Trusts have been assessed against the indicators relevant to them and a risk score has been calculated.
Shadow health minister Jamie Reed said: "David Cameron should be ashamed that he's put so many of England's hospitals in this position.
"He siphoned £3 billion out of the NHS front line to blow on a back-office re- organisation nobody voted for.
"Hospitals were left on a financial knife-edge and they are clearly struggling to maintain standards of patient care after more than three years of chaos.
"Almost 6,000 nursing jobs have been axed since the election and David Cameron presided over the first summer A&E crisis in living memory.
"The NHS is on the brink of a very dangerous winter. David Cameron cannot continue to ignore the warnings.
"This is further proof that you can't trust the Tories with the NHS."
A Department of Health spokesman said: "Following the Francis Inquiry, the CQC has introduced radical changes to hospital inspections, with a new Chief Inspector, Sir Mike Richards, leading significantly larger inspection teams which are headed up by clinical and other experts.
"This next step will help to give the CQC a good picture of risk within trusts.
"Patient safety should be the first in everything the NHS does and we expect the CQC to act where it finds failings of care."
It is understood that the Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, which is in band 1, will be placed in special measures.
Dr Mark Porter, chairman of the British Medical Association (BMA), said: "Having this array of information in the public domain is an important step towards improving transparency across the NHS, informing and empowering patients and shining a light on hospitals which are not performing to the standard we expect.
"Hospitals are large, complex organisations so we need to avoid oversimplifying or reducing vast amounts of data to a simple band or rating.
"It goes without saying that where trusts are found to be operating below par we urgently need to identify where the problems lie and find a solution.
"The fact is many trusts are buckling under extreme financial pressure. The NHS is having to make £20 billion of savings, leading to increasing pressure on staff and resources and, most worryingly, affecting patient care and outcomes.
"Many hospitals are stretched to breaking point. If we are to deliver the improvements patients and doctors want to see, the Government needs to address the significant funding gap in the NHS."
Christina McAnea, head of health at the Unison union, said: "This is a shocking indictment of this Government's management of the NHS.
"Even if these are just indicators of where there may be more serious problems, this is a very high figure.
"Individual trusts will need to take action but this should also set off a major alert in the G overnment that their policies are seriously damaging the NHS.
"Funding cuts, job losses and the impact of major, unnecessary structural reforms have left some parts of the NHS in chaos.
"Staff and mangers are working hard to deliver quality care for patients against a backdrop of a Government that seems more interested dismantling the NHS in England than improving patient care and safety."
Peter Walsh, chief executive of the Action against Medical Accidents charity, said: "The results may be worrying, but we very much welcome the more proactive approach by CQC which is more likely to identify dangerous trusts.
"What we most need now is action to put things right before more patients are needlessly harmed."
Health Secretary Jeremy Hunt said the CQC's findings were worrying but there would be far more transparency under the coalition Government than during the Labour administration.
He told BBC Radio 4's World At One: "Of course it's worrying to find that out. But what the public should be reassured by is, first of all, we are never again going to have a situation where the NHS knows information that the public doesn't.
"Secondly, we have introduced a very rigorous inspection regime which means that each one of these hospitals will be inspected very soon and we will really get to the bottom if there is a problem, and if there is we will put them into special measures and sort it out.
"That is a world apart from what happened before, where ministers refused to have a public inquiry into Mid Staffs, where regulators were leaned on so they felt they couldn't come out with bad news, where they abolished expert inspections so you had the same people inspecting hospitals as inspecting dentists - completely crazy.
"Really what we have got to do is be totally honest with the public about where there are problems and then sort the problems out quickly."
He dismissed the suggestion that funding cuts were to blame for poor care, but said it was important to discover whether problems such as a "lack of nurses" could be responsible for failings.
Mr Hunt said: " Funding is tight across the NHS, it's tight across the whole public sector. But what I would say is there are hospitals which have difficult financial challenges that are still delivering superb care.
"Look at the places like Salford Royal, the QE Birmingham, some of the big London hospitals, where you get absolutely world-class care.
"It is possible to deliver really good care even when times are tough. What we need to do is to get to the bottom of the problem and work out whether it's weak management, whether it's bad IT systems, whether it's a lack of nurses and then make sure we sort out those problems really quickly."
He said under Labour whistleblowers felt unable to speak out and "even the regulator was told by ministers 'be careful about any news you issue in the run-up to an election', which is an extraordinarily irresponsible thing when you are talking about reports of poor and possibly unsafe care for patients".
Mr Hunt said that "overall there are around 500 more hospital nurses across the country than when we came to office and there are 5,500 more doctors".
But he was cautious about the suggestion that there should be fixed ratios for the number of staff to patients: "We have got to be careful about mandating a figure that then leads to a race to the bottom when in fact what we need is much more care in some of the wards where you have more vulnerable people.
"What we are looking at is whether you can find a model which identifies very publicly, so that the public know on a month-by-month basis 'is the care in a hospital safe, are the staff ratios adequate'. I absolutely agree that we should know that as well as the NHS , as well as the hospital itself."