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The pandemic affected stroke services as it did almost every area of healthcare so it should not be too surprising that the proportion of trusts given A or B ratings in the national stroke survey has declined.

The nature of that decline is quite striking though. Those units which routinely admit acute patients and had A or B ratings fell from 69 per cent to 57 per cent over two years. Some areas – not necessarily those worst affected by the pandemic – saw the majority of their units downgraded (the South West had two thirds marked down).

That amounts to worse care for thousands of stroke patients. But it is only half the picture. The collapse in ambulance response times for category two patients – which include suspected strokes – is likely to mean patients getting to hospital later and, in some cases, missing the timeframe for treatment which can improve their chances of recovery. HSJ has previously reported on the drop in the percentage of patients having thrombolysis.

Unlike electives, there is no recovery plan in sight for the stroke pathway and little sign that ambulance response times – a key part of it – will improve dramatically any time soon.

Intensive care but not intensive quality

A national report has found three intensive care units for children are not meeting recognised quality standards.

A report from NHS England’s Getting it Right First Time programme has found the paediatric ICUs at Royal Stoke University Hospital, Royal Brompton Hospital in London and Freeman Hospital in Newcastle do not offer specialised paediatric surgery.

This is despite national guidance saying that all paediatric ICUs with level three beds for the most seriously ill children – which the three units offer – should have specialised surgery co-located on site.

The report has highlighted the variability and “poor alignment” of specialised paediatric services across the ICUs.

Freeman Hospital’s unit, a specialised heart unit for children, is set to be moved to Newcastle’s main hospital in a major new capital plan. Royal Brompton Hospital has merged with Guy’s and St Thomas’ Foundation Trust in a move the trust says will mean expertise is shared across the organisation. The trust which runs Royal Stoke Hospital insisted patients admitted to its paediatric ICUs “are treated in line with national guidance” – but were not specific about which.

Also on today

In our expert briefing North by North West, Lawrence Dunhill notes the exodus of senior directors from NHSE’s North West team in recent months, and speculates on the directorate’s long-term future. And The Primer offers our weekly rapid-fire rundown on health coverage across a range of media sources.