Special measures: one year on

Published: 30 July 2014 Page last updated: 12 May 2022

In 2013, Sir Bruce Keogh led a review of 14 NHS trusts (nine NHS foundation trusts and five NHS trusts) that had high mortality rates. The review identified problems relating to quality and safety and/or leadership in all 14 trusts. 11 of the 14 were put into 'special measures'.

What are special measures?

The special measures regime is new to the NHS. When a trust is placed in special measures by Monitor (for foundation trusts) and the NHS Trust Development Authority (for NHS trusts):

  • An improvement director can be appointed to provide assurance of the trust’s approach to performance.
  • The NHS TDA or Monitor review the capability of the trust’s leadership.
  • A ‘buddy’ trust may be chosen to offer support in the areas where improvement is needed.
  • Progress against action plans is published monthly on the trust’s website and NHS Choices.

What progress have the trusts made?

We reassessed all 14 trusts earlier this year, using our new, more comprehensive inspection approach. We have published reports on each of the 14 inspections.

Special measures: one year on gives an overview of the progress made by the 11 trusts that were placed in special measures. The Chief Inspector of Hospitals has concluded that significant progress has been made at 10 of the 11 trusts.

  • Two have made exceptional progress and have been rated ‘good’ overall.
  • Three have made good progress. Although they still require further improvement, the Chief Inspector has recommended they should exit special measures with ongoing support.
  • The Chief Inspector has recommended five trusts remain in special measures. These will be inspected again in six months to ensure they are continuing to make progress.
  • One trust has failed to make significant overall progress (Medway NHS Foundation Trust) and will continue in special measures while further urgent support is provided or a long-term solution is found.

Trust by trust: progress since 2013

After the 11 trusts were reinspected in 2014, the Chief Inspector of Hospitals made the following recommendations.

Exit from special measures

  • Basildon and Thurrock University Hospitals NHS Foundation Trust
  • George Eliot Hospital NHS Trust

Exit from special measures with some continued support in place

  • Buckinghamshire Healthcare NHS Trust
  • East Lancashire Hospitals NHS Trust
  • Northern Lincolnshire and Goole NHS Foundation Trust

Remain in special measures for an extension period of six months

  • Burton Hospitals NHS Foundation Trust
  • North Cumbria University Hospitals NHS Trust
  • Sherwood Forest Hospitals NHS Foundation Trust
  • Tameside Hospital NHS Foundation Trust
  • United Lincolnshire Hospitals NHS Trust

Continue in special measures while further urgent support is provided or a long-term solution is found

  • Medway NHS Foundation Trust

What factors helped trusts to improve?

No single factor accounts for the improvements the trusts have made. However, there are strong indications that the following were factors for success:

  • Strength of leadership.
  • Accepting the scale of the challenges faced.
  • Alignment or engagement between managers and clinicians.
  • Willingness to accept external support from a buddy trust.

Our findings visualised

Find out about the background behind Special measures: one year on and what we found when we reinspected the trusts this year.

Special measures for NHS trusts was replaced by the Recovery Support Programme in July 2021