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

The slow road to the specialist centre

NHS England is redoubling efforts to reconfigure acute stroke services.

There is wide recognition of the benefits to patients from centralising acute stroke care into 24/7 units that can provide the better treatment. The London reorganisation of 2010 is credited with saving almost a hundred lives a year every year.

Yet there is much contention when this comes to be applied to each region. 

And despite multiple attempts to spread the model, progress has been quite slow, in no small part because of staff, public and political opposition.

As part of its NHS long-term plan, NHS England has signalled it will have another push.

HSJ has seen independent modelling that suggests the right final number would be 80 acute centres, to ensure equality of access to the best treatments – many less than the current 126 acute units. 

Such a reorganisation would see many patients facing longer travel times, up to 45 minutes – an issue sure to set alarm bells ringing – particularly in rural areas.

Indeed, a current plan in Kent and Medway to make these changes is already being threatened with a judicial review precisely because patients are worried about local access.

Although 80 centres might be the logical, evidence-based outcome, there is likely to be a recognition that, once various communities’ views and emotions are taken into account, the number of units is probably going to be higher than this for the foreseeable future.

Wrestling with WRES

We published some analysis of NHS England’s 2018 cut of workforce race equality standard data. Comparing the recently published numbers to that for 2017 shows 96 trusts said they had no BME board members at all, just two fewer than in the 2017 data. The data reported on 231 trusts in total.

Just one trust – Black Country Partnership Foundation Trust – states it has as many black and minority ethnic board members as white, and none say their boards have more than 50 per cent BME makeup.

Across all trusts, 7.4 per cent of board members were from a BME background in 2018. The NHS workforce overall is about 20 per cent BME.

At some trusts the proportions have gone down.

The numbers are tricky: NHS England publishes percentages, not raw numbers of members. With boards being quite small groups of people, comings and goings of one or two change the percentage makeup a lot. And some trusts told HSJ that their figures as published by NHS England were wrong, anyway.

The analysis sparked debate, too, among readers commenting on the piece about what representation should be expected, or aimed for, from trust boards, and on the right way to record and report on the information.