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Special measures: NHS trusts

  • Organisations we regulate

Special measures apply to NHS trusts and NHS foundation trusts that have serious failures in the quality of care.

This is usually when:

  • they are rated inadequate in at least two out of the five key questions at trust level with one rating of inadequate for well-led
  • we have concerns that the existing management cannot make the necessary improvements without extra support.

There will be no change to the criteria for entry into special measures for quality reasons and the criteria for exit. CQC’s recommendation for trusts to enter special measures for quality reasons will continue to be based on the five quality key questions.

We want to ensure that services providing inadequate care do not continue to do so. We can therefore recommend to NHS Improvement that the trust is placed into special measures.

The purpose of this is to:

  • Ensure that providers found to be providing inadequate care make significant improvement.
  • Enable us to use our enforcement powers in response to inadequate care and to work with other organisations to ensure that care improves.
  • Provide a clear time frame for providers in which to improve the quality of care. If they do not, we will take further action, for example we have the power to require NHS Improvement to place a foundation trust in special administration, or to recommend to the Secretary of State that an NHS trust be placed into special administration.

How special measures works

Trusts in special measures receive support from NHS Improvement to make the necessary improvements. This involves appointing an improvement director and securing external support from another trust. The trust’s senior leadership may also be strengthened.

We usually re-inspect the trust at any time within 12 months of it going into special measures. If we have significant concerns about quality, we will carry out another inspection sooner.

During the special measures period we will keep regular contact with the trust and NHS Improvement to discuss progress. If there is enough evidence of good progress NHS Improvement may recommend an earlier inspection. At this stage if we feel the trust has made enough progress we will recommend that it is taken out of special measures.

If the trust has not made sufficient progress when we re-inspect we will consult with NHS Improvement to decide whether it should remain in special measures or if we need to take further action.

We developed our approach to special measures for NHS trusts with NHS Improvement.

Financial special measures

NHS Improvement has a further set of criteria that it uses to determine if a trust should be placed in financial special measures.

Read the guidance on financial special measures on the NHS Improvement website.

Last updated:
01 March 2018