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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 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.

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.

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.