Failing hospitals: Are there more out there?
The publication of the Keogh review into the 14 hospital trusts with the worst death rates has been widely trailed in advance.
The media has been full of stories of hit squads being sent into the worst ones, while Labour and the government have slugged it out on the airwaves over who is to blame for the problems.
But now the report has been published there are perhaps as many questions left hanging as answers provided.
We now know none of the 14 has been given a clean bill of health.
Indeed, the problems are so acute in 11 that a team of external experts - the hit squads as they have been dubbed - will be sent in to make sure progress is made.
But the fact that Prof Sir Bruce Keogh and his team found such large scale failure prompts the question why it was not obvious to those in charge of inspecting hospitals.
Among the most worrying findings were a spate of stillbirths being ignored, boards struggling to analyse data properly, operating theatres that were not up-to-scratch and patients left pleading for help.
These were basic failings that raised questions marks over the whole way the trusts were being run.
End Quote Care Quality Commission spokeswoman
We recognise the way we have been inspecting hospitals is flawed”
And yet the Care Quality Commission (CQC), which is in charge of monitoring performance of services, only has warning notices in place on two trusts.
When quizzed about that disconnect, Sir Bruce said it once again emphasised the fact that changes in the way hospitals are regulated were needed.'Poor performers'
Indeed, the CQC was quick to point out that a new system is in the process of being phased in.
A new chief inspector of hospitals, Sir Mike Richards, has been appointed and is due to set out his plans later this week.
The 13,000 deaths figure
Ahead of publication of the Keogh review there was much speculation that it was going to suggest many patients died needlessly at the hospitals.
But the investigation was never designed to look for avoidable deaths.
Mortality data was used to identify which trusts were to be investigated and then the review team looked at the quality of care being provided.
In fact, the report seemed to take issue with the reporting of the 13,000 figure, which was based on modelling done by academic Sir Brian Jarman, who helped with the review.
Sir Brian's figure refers to the number of excess deaths. That is to say the number above what would be expected for that type of hospital. To determine whether they were needless would require a detailed examination of case notes.
The Keogh review said it was "clinically meaningless and academically reckless" to link such a figure to avoidable deaths.
That seems to contrast somewhat with the way Health Secretary Jeremy Hunt described the problems at the 14 trusts when he announced the findings in the House of Commons.
He said mortality rates suggest "thousands more people may have died that would be normally expected".
Prof Sir Bruce Keogh was asked by journalists about the wording used by Mr Hunt. But the use of the word "may" by Mr Hunt allowed him to argue that he and the health secretary were not at odds.
Already the regulator has said there will be a tougher, more rigorous processes.
But it was contrite about its failings in the wake of the publication of the Keogh review.
"We recognise the way we have been inspecting hospitals is flawed," a spokeswoman said.
However, that then raises the possibility that there are other failing hospitals out there that should be in special measures.
The 14 investigated in this review are basically a snapshot of poor performers.
They were chosen because they have the worst death rates on two measures for the past two years.
The worst 20 could easily have been chosen or another trigger - poor results in patient surveys or high levels of sickness absence among staff - could have been used to identify a different set of potential poor performers.
Would this have led to a different group of trusts being put into special measures?
When Sir Bruce was asked this, he simply said: "I don't know."
The challenge now for the NHS and those in charge of monitoring it - the regulators, NHS England and the government - is to identify exactly how widespread poor performance is.
Everyone is agreed the majority of patients receive good care, but it is becoming clear that the size of the minority who aren't is - worryingly - unknown.