How did one NHS trust become among the country's worst?

In March, the government announced a recovery programme for some of the "worst" NHS services in the country.

One of the five was East Kent Hospitals University NHS Foundation Trust.

The trust, which runs five hospitals in Canterbury, Margate, Ashford, Dover and Folkestone, currently ranks 124 out of 134 in the NHS league tables.

A spokesperson for the trust said at the time the recovery programme was announced that it welcomed the bespoke support and looked forward to "significant, sustained and positive change".

But how did this situation come about? What challenges does East Kent Hospitals face? And can it turn things around?

Alison Moore, a journalist at the Health Service Journal, said many of its staff were "very good, committed and dedicated" people.

But she added: "A whole bunch of things have gone wrong for the trust."

Moore told the BBC that one challenge was the legacy of a maternity scandal.

There has been a national inquiry into East Kent Hospitals' maternity services after a review found that up to 45 babies might have survived with better care.

Moore said this scandal was not only "enormously demoralising" for staff, it also led to the trust putting "a lot of effort and money" in to improving the service.

While things here had got better, she said this focus meant it had "dropped the ball" in other areas.

Maternity services at the trust's William Harvey Hospital in Ashford and Queen Elizabeth The Queen Mother Hospital in Margate were rated good by the Care Quality Commission in 2025.

Danielle Jefferies, senior analyst at the King's Fund, told the BBC another challenge facing the trust - one of the largest in England - is the number of hospitals it manages.

"They've got a really complex mix of activity going on - it is a lot of pressure," she said.

Its size also creates high costs, Jefferies added.

"They are in a tough financial position," she said.

Hospital bosses previously said they were "on track" to deliver massive savings, though still expected a deficit of £88.5m for the 2024-25 financial year.

East Kent Hospitals also covers a big geographical area, which creates additional costs in transporting patients across large distances, according to Moore.

A "big issue" facing the trust, Moore continued, was that some of its buildings were "quite old".

"They're not very efficient to run - both in terms of energy costs and in terms of workflow through them," she continued.

Moore said that every year East Kent Hospitals gets a certain amount of money from the government to spend on its infrastructure.

But she continued: "There is a long list of things.... [and] the money never lasts to the end."

The BBC reported in 2024 that cancer patients were being cared for in leaking, mouldy and damp buildings owned by East Kent Hospitals.

The trust at the time said it recognised the limitations of the "ageing estate" and that it was working to bring future improvements.

Like many trusts across the country, Moore said East Kent Hospitals faces "demographic challenges".

"It does serve some quite deprived areas, especially along the coast," she said.

She added that Kent had also seen quite a few care home closures in recent years, which can cause bed blocking.

"Quite a lot of its [hospital] beds are occupied by people who actually don't need to be there and probably would be much better off elsewhere," Moore continued.

Senior analyst Jefferies added that NHS trusts in more rural and coastal areas - like East Kent Hospitals - often find it difficult to recruit hospital staff.

"Younger doctors and nurses want to go to central urban places," she said.

Moore continued the trust had had a "rapid turnover of people at the executive level over the last few years".

"It's been a difficult gig, frankly," she said.

"One shouldn't underestimate the emotional strain of doing such a job against so many different challenges."

The Department of Health and Social Care and East Kent Hospitals University NHS Foundation Trust have been approached for comment.

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