Medway Maritime is the only hospital in the country staying in special measures indefinitely after a review – putting the trust at risk being dissolved.

The Keogh review into death rates, published this week, reveals 10 of the 11 trusts in special measures have made good progress but Medway is failing to make necessary changes.

Chief inspector of hospitals Sir Mike Richards said Medway had made “little progress” since July 2013, except in relation to maternity services, and actions taken had not worked.

He said: “The trust is rated inadequate overall and gives rise to major concerns.

"CQC (Care Quality Commission) is working closely with Monitor to consider what further urgent action needs to be taken. CQC will not accept this continued poor care.”

Health watchdog CQC can make amendments to Medway’s registration if care does not improve, which means it can make changes such as reducing the number of inpatients on certain wards to ensure there are enough staff to provide adequate care.

In exceptional circumstances, it can also enforce change though the “special administration regime” – when trust special administrators are appointed by health regulator Monitor to take control of the trust’s affairs.

This action is taken when a trust is deemed to be unsustainable in its current form.

Since the regime was established in 2009, it has been used twice: first in July 2012 at South London Healthcare NHS Trust, and again in April 2013 at Mid Staffordshire NHS Foundation Trust. Both trusts were later dissolved with services run by other trusts.

In the latest joint report from the CQC, Monitor and the NHS Trust Development Authority, unstable leadership and poorly defined strategy were outlined.

The report said frontline staff had not presented a clear vision and they did not feel the executive team was visible enough.

Monitor appointed Christopher Langley interim chairman in February on a one-year contract, with a salary of £200,000 a year.

Nigel Beverley was appointed interim chief executive at the same time, on a six-month contract and was paid £1,450 a day. He has since been replaced by acting chief executive Philip Barnes.

A report earlier this year revealed the hospital had hired more than 30 interim managers for six-figure sums.

Despite the money invested in new leadership, a detailed inspection of Medway Maritime in April resulted in multiple inadequate ratings.

Sir Mike recommended Medway remain in special measures until urgent improvements are made.

The financial sustainability of the trust was a particular concern, with a deficit of £10m in 2013/14 and a significantly higher deficit forecast for 2014/15.

Following the report, chief nurse Steve Hams said the hospital was working with staff, partners and patients to make rapid improvements.

Of the 11 trusts put into special measures following Sir Bruce Keogh’s review of trusts with high mortality rates, two have made exceptional progress and are no longer in special measures.

A further three have made good progress but remain in special measures with continued support. Five remain in special measures for a further six months, after which they will be inspected again to ensure that they are continuing to make progress.