The must-read stories and debate in health policy and leadership.

In September 2019, Matt Hancock told The Sunday Times building would start immediately on up to six NHS hospitals which he said had advanced plans for major redevelopment.

The announcement was backed by a promised £2.7bn allocation by 2025, which has since been increased to £3.7bn.

More than two years on there has been little sign of spades in the ground at the trusts in question – the so-called “pathfinders”.

The pathfinder trusts, which were originally hoping to complete their projects by around 2025, are waiting an increasingly long time for the green light from the government.

However, once the green light is given, there may be less money available than hoped.

Yesterday HSJ revealed that the funding initially set aside for the pathfinder trusts will also now cover extra costs associated with eight other capital projects which were not part of the original “40 new hospitals” programme.

Several of these eight projects, named “in-flight” by the government, were approved and funded prior to the programme, and they include the hugely over-spent schemes in West Birmingham, Liverpool and Brighton.

The government has now assembled a team to review the “in-flight” projects to see how this will impact on the availability of funding for the pathfinder trusts.

From a government perspective, transferring major building projects into a single national construction programme may make sense.

But for local trusts which have been promised shiny new hospitals, the incorporation of long-delayed and expensive schemes into their slot could have very disappointing financial consequences.

Stroke care’s big setback

Stroke care is set to take a massive hit, according to leading doctor Professor Martin James.

He says the NHS is set to miss the long-term plan’s target for improving stroke care by several years, and: “We can’t blame everything on the pandemic.”

He added: “It was probably inevitable when the target was published that it would not be achieved.”

In 2019 the NHS long-term plan set a target for 10 per cent of stroke patients to be treated with thrombectomy – the mechanical removal of clots in the brain – by 2022. But the number of patients treated with thrombectomy has stalled at about 2 per cent.

There was a gradual increase in the number carried out in 2019, peaking at around 2.2 per cent, but by the end of 2020 this had fallen to 1.8 per cent, according to a paper presented at the World Stroke Congress.

More recent data shows that in the second quarter of 2021, there were 23,282 strokes entered into the national stroke audit system, with just 527 thrombectomies performed — a slight improvement on 477 in the first three months of the year. That gives a rough estimate of about 2.3 per cent. 

Professor James, a trustee of the Stroke Association and clinical director of the Sentinel Stroke National Audit Programme, told HSJ there had been a lack of infrastructure investment and not enough extra staff trained to deliver thrombectomy. Read the full story, with NHS Engand’s comment, here.