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Special measures

About special measures

When there are concerns about the quality of care that hospitals are delivering, they can be put on special measures.

Special measures are designed to offer trusts the support they need to improve, as well as giving the public the ability to hold them to account.

NHS Improvement is responsible for putting both foundation trusts and NHS trusts on special measures. 

NHS Improvement is the operational name for the organisation that brings together Monitor, the NHS Trust Development Authority, Patient Safety, the National Reporting and Learning System, the Advancing Change Team, and the Intensive Support Teams.

One trigger for a trust being put on special measures is a recommendation from the Chief Inspector of Hospitals, which may be made after a routine inspection.

Special measures typically include the following:

  • The trust will be partnered with a high-performing NHS foundation trust or NHS trust to help deliver improvements. The high-performing partner trust will be reimbursed for its time and, where appropriate, will have access to an additional fund through which it could be paid extra if its help produces real results.
  • The trust will produce a regularly updated action plan, published on the NHS Choices website, detailing the progress being made.
  • The trust will have an improvement director – appointed by and accountable to NHS Improvement – who will monitor progress and provide an early warning if there is any risk the trust will not deliver its action plan.
  • Because foundation trusts have additional freedoms, NHS Improvement may suspend some or all of the freedoms a foundation trust has to operate as an autonomous body. This could mean losing the freedom to appoint its own executive teams or set its own operating plan.
  • The leadership of the trust will be reviewed as appropriate. Changes to the management of failing trusts will be made if necessary to ensure that the leadership is best placed to drive the required improvements to the quality of services throughout the special measures period and beyond. Improvements will not be held back by leaving a weak leadership in place.

Special measures are designed to produce results quickly. A trust is usually expected to have made improvements within 12 months, at which point it will be inspected by the Chief Inspector of Hospitals.

For more detailed information, download the special measures FAQ (PDF, 159kb).  

The providers currently on special measures – with links to their monthly updates – are:

Trusts no longer on special measures

NHS Improvement has made the decision to take the trusts listed below out of special measures after they improved their services for patients:

NHS Improvement also decided to take Heatherwood and Wexham Park Hospitals NHS Foundation Trust out of special measures after services improved through an acquisition. 

Also read the report published by NHS Improvement and the Care Quality Commission on the progress made by the 11 trusts put on special measures in July 2013.

Page last reviewed: 04/04/2016

Next review due: 04/04/2019

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