NHS hospitals with the biggest death rates in England, including Medway Maritime in Gillingham, are being teamed up with those given top marks for safety and patient care.

Eleven trusts are in special measures following the death rates scandal at Stafford hospital.

Managers from the best performers will be sent in to drive up standards, it's been revealed.

It comes after Medway - Kent’s biggest hospital - was placed in special measures amid a vast catalogue of failings.

Details of what shape the changes will take in Medway are unconfirmed but it could mean losing the freedom to appoint executives or set operating plans.

Current executives may also be sacked.

Almost every senior board member at Medway has already been replaced in the last two years except the chief executive, Mark Devlin.

Which hospital trust will work as a partner with Medway has yet to be confirmed.

It will be paid bonuses if standards at Medway improve, echoing a culture which exists in schools.

Meanwhile, Medway’s hospital trust will publish monthly improvement plans on the NHS Choices website, with the first one due out today.

The hospital is already addressing the out-of-date A&E department by setting up a mobile unit and refurbishing the original wing.

Health Secretary Jeremy Hunt said today: “In place of the old approach of paying management consultants to analyse the problems, we are giving contracts to the best in the NHS to implement solutions they have tried and tested.

“With the help of inspiring NHS leaders and their teams from our leading hospitals, I am confident that we can get these hospitals out of special measures and on the road to recovery.”

The changes stem from a review by NHS medical director Sir Bruce Keogh, which probed the 14 hospitals with the highest death rates in England.

Health secretary Jeremy Hunt told MPs in July: “A public consultation [in Medway] heard stories of poor consultation with patients, poor management of deteriorating patients, inappropriate referrals and medical interventions, delayed discharges and long A&E waiting times.”

The report’s damning findings included:

• Staffing levels so low that they are potentially unsafe, “undoubtedly” caused by cost saving programmes including the closure of 60 beds over the last three years. Problems are especially bad at A&E, the High Dependency Unit and Acute Medical Unit.
• Junior doctors frequently having to make decisions beyond their level of skill, especially in heamatology and orthopedics.
• Junior doctors frequently left in charge of parts of the High Dependency Unit, where a quarter of all patients die. Despite this being higher than expected, the panel saw no evidence of the hospital carrying out any in-depth review to find out why.
• A “large number of committed and concerned staff who frequently reported that they feel unable to raise patient safety concerns and when they do, little or no action is taken.”
• No clarity on who was in charge of finding the root cause of all deaths - despite death rates being consistently high, at 232 more than expected last year.
• Not enough action taken to prevent very sick patients deteriorating, especially out of hours and on weekends.
• Poor management of bed occupancy and flows throughout the hospital.
• An A&E department where staff struggle to cope with a “totally unsuitable layout” with “frequent use of escalation wards, overstretched staff and a failure to predictably and systematically manage patients on the correct care pathway, including critical care”. Medway had the third-slowest waiting times in the country between April and June this year.
• A “lack of clear focus and pace at board and executive level” to improve safety. Board members focused so heavily on a planned merger with Darent Valley Hospital, Dartford, that they put no improvement strategy in place for services and buildings at the Medway site.

The panel interviewed top directors at the Gillingham hospital as well as staff and patients earlier this year.

Its report noted many senior staff had been replaced since the Keogh review was announced - including new directors of nursing, communications and strategy and governance.

A new medical director has been appointed, and the chairman and finance director were also replaced last year.

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