• emergency care systems

Professor Sir Bruce Keogh's much anticipated report into the quality of care in 14 English National Health Service (NHS) trusts was released in July.1 Judging by some of the media fanfare in the days leading up to its release, casual observers would have concluded that 14 more Mid-Staffordshire type fiascos were about to be unearthed. This was not quite the case, however, as became clear once the report was available, a launch accompanied by the calm reflections of Keogh himself.

The investigation into the trusts wanted to see if there were are any sustained failings in the quality of care and treatment they offered and identify if:

• action by the trusts to improve quality is adequate and if more steps were needed.

• extra external support should be given to the trusts to help them improve.

• there were any areas that needed regulatory action to protect patients.

In all 14 hospitals, the investigators found examples of good care as well as ones where improvement is needed urgently. They also found boards and management teams struggling to understand and deal with the complex causes of high …