UNCLEAR ‘pathways’ for dealing with acutely ill and deteriorating patients and the transfer of patients between Wycombe and Stoke Mandeville were among the areas highlighted for concern by the Keogh review.

Buckinghamshire Healthcare NHS Trust is one of 11 hospital trusts which has been placed in special measures because of major failings, the health secretary announced this afternoon.

Sir Bruce Keogh led the review into 14 Hospital Trusts whose mortality ratios have shown higher-than-expected rates for the past two years, following the publication of the Francis Report into catastrophic failures at Mid-Staffordshire Hospitals.

Investigations into the trusts came in the form of announced and unannounced visits and various forms of data that were collected. A Risk Summit action plan was than agreed, following the findings.

The national report published today noted that , for Bucks: “the Trust and ward areas were found to be clean and tidy, with patients generally seen to be well cared for” during the visit of the investigators.”

Findings also noted that many patients were complimentary about the care they received from staff, some of whom were described as ‘outstanding and dedicated’.

However, the report stated that some of the issues of concern at Buckinghamshire Healthcare NHS Trust required immediate escalation. These were as follows:

• The panel identified the lack of clear and formally agreed pathways for the recognition and management of acutely ill and deteriorating patients, particularly in areas where there is higher mortality such as pneumonia and acute renal failure.

• The review panel observed patients who required transfer between the two sites. To improve patient experience and safety this needs to be more consistently managed through an agreed clinical process.

• Community nurses reported experiencing delays accessing medical advice out of hours (the NHS 111 service is provided by Bucks Urgent Care).”

The review went on to list several other concerns in need of urgent action at Bucks.

These are as follows:

• The Trust needs a more robust method to provide assurance on the impact of major service change on quality of care, especially in regard to the consolidation of A&E at the Stoke Mandeville site.

• Leadership at Board level appears “reactive” to issues and there seems to have been limited challenge and examination of the data presented to the Board.

• The panel had a concern over staffing levels of senior grades, in particular out of hours. The Nursing staffing levels and skills mix was also found to be suboptimal in places.

• While there are a number of recent developments which focus on safety (e.g. National Early Warning Scores), the Trust needs to adopt national initiatives in developing a mature “safety culture.” They need to use incident reporting positively and constructively alongside more proactive tools.

The report then goes on to state that: “The Trust accepted the highlighted areas for development and responded positively to the process.

"An action plan was agreed at the risk summit addressing all the urgent priority actions discussed. The Trust is to provide a detailed action plan to all outstanding concerns and recommended actions included in the Rapid Responsive Review report.”

It added that the follow up of the action plan will be undertaken by key organisations within the system, including the Trust Development Agency, with a formal follow up to take place later in 2013

Click here for Buckinghamshire Healthcare NHS Trust response to the report.

Click here to see the full reports.