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

There’s no argument that intensive therapy after a stroke can make a difference to outcomes for many patients, helping them regain a higher level of independence and functionality.

But, as HSJ revealed yesterday, less than one patient in six gets 45 minutes, five days a week, of the physio, occupational and speech and language therapy they are judged as needing. This is likely to fall further when performance is judged against the new NICE recommendations for three hours of therapy, five days a week.

This reflects workforce pressures in many trusts – a shortage of therapists to deliver the work, although some trusts also cited a shortage of admin staff to input the data (it’s not clear this would have made much difference to their results). Perhaps most shocking is the low performance of units with “stroke” or “rehab” in their name.

NHS England is keen to point to improved community rehabilitation services for stroke patients. However, it is not clear that this gets anywhere near the NICE recommendations either. Until they are met, patients will lead more limited lives than they need to after stroke.

Safe cracker

A major trust has appointed a former regional NHS England director as its group chief medical officer, who is known for leading a project which has transformed the way elective patients are prioritised. 

Kiran Patel is stepping into the newly created role at University Hospitals Birmingham as it moves into a group model with a central board and executive teams for its four hospital sites. Until 2019, he was NHSE’s medical director for the West Midlands and also worked as a cardiologist at UHB.

Professor Patel will help to lead UHB’s recovery from a series of high-profile scandals over the past year, with major concerns raised around patient safety, leadership and culture.

The trust’s medical services have also come under fire after the experience of junior doctors in the trust’s haematology and obstetrics and gynaecology departments was heavily criticised by regulators.

In his current role of chief medical officer at University Hospitals of Coventry and Warwickshire, Professor Patel has helped develop one of the leading NHS “agile waiting list” programmes designed to factor in health inequalities, with dozens of trusts considering adopting its software.

UHB’s outgoing chief medical officer, Simon Ball, announced his departure amid an executive clearout in September.

Also on today

With NHS England chiefs conceding privately that the target to virtually eliminate 65-week waiters by March won’t be met, James Illman in Recovery Watch asks what would represent a good result for where long waiters land by the end of 2023-24. And we report that moving less complex procedures out of operating theatres and into other care settings to free up capacity to support elective recovery has “inadvertently” increased the risk of “never events” at an acute trust, according to a report.