The NHS Risky Rectangle: a Bermuda Triangle for hospitals?

NHS acute trusts vary widely in quality. It’s quite easy to spot the good ones – they appear regularly in the media, they win awards and they are famous as organisations. It’s certainly not always the case, but an appetite for attention tends to indicate an organisation that is proud of what it does and where staff have confidence to talk about what they are doing right – as well as a press office and management team happy to let them. Their ranks include Cambridge University Hospitals, King’s College Hospital, Salford Royal, Great Ormond Street, The Christie and University College London Hospitals.

These are familiar names, but the general public is unlikely to be so familiar with those trusts which perform poorly. They might get discussed in off-record briefings, but it has almost seemed like a breach of NHS etiquette to name names – until things go very badly wrong, at which point the likes of Mid-Staffordshire become a by-word for what’s wrong with the NHS. For the media, it is a lot easier to write about successful trusts than poorly-performing ones, if only because it is easier to get interviews from the former. But it’s those trusts that look risky yet are not notorious that we most need to know about – to allow patients a better-informed choice on whether to use them, to help their staff speak out about problems and to put public pressure on their managers to improve.

Last week saw this identification get rather easier, with the publication of the Care Quality Commission’s categorisation of England’s acute healthcare providers by risk of providing poor care. The familiar names mentioned earlier are all in bands 5 and 6, the least risky. There are few familiar names among the 24 in Band 1, the highest risk – one of the exceptions being South London Healthcare NHS Trust, which has recently been split up between neighbouring trusts.

But unless they are your local hospitals, you would be forgiven for not having heard of the following: Burton Hospitals, George Eliot Hospital in Nuneaton, Northern Lincolnshire and Goole Hospitals, Sherwood Forest Hospitals and the Queen Elizabeth Hospital King’s Lynn. These are the five the CQC believes present an elevated risk, “due to known serious concerns”. Sherwood Forest has on occasion talked about its work with Unipart on redesigning processes; the others have pretty low profiles.

That deserves to change, not least because all five are in a rectangle of mainly rural eastern England marked out by the Wash, Spaghetti Junction, Leeds and the Humber. As well as all the five with elevated risk, the NHS Risky Rectangle also includes several big trusts in Band 1, including Leeds Teaching Hospitals, United Lincolnshire Hospitals and University Hospitals of Leicester. Residents of Lincolnshire, in the centre of this area, look to have a tougher job than most in finding a hospital not on the CQC’s critical list.

The CQC has done the right thing in publishing this list, and now others need to start asking questions of the trusts in the lowest bands. They deserve to be more famous; better that, than any of them later becoming infamous.

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