Category Archives: NHS managers

Golden goodbyes for NHS managers soar to £39m

Its quite surprising that managers who will not get jobs outside the health service (except in health providers) are so “valued”. The doctors who move into management are considered to have “moved to the dark side”, as their colleagues appreciate that the philosophy is unsustainable and the hoops they are asked to jump through are mostly pointless. This applies in both Hospital and GP land. As referrals are “blocked” more taxpayers will have to go private…

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Nadeem Badshah in the Times 16th September 2017 reports: Golden goodbyes for NHS managers soar to £39m

Spending on golden goodbyes and voluntary redundancy deals has risen eight-fold in a year at the Department of Health, according to official figures.
A parliamentary answer reveals that more than 700 staff left the department in 2016/17 due to restructuring and cost-cutting programmes.
The figures, which cover the DoH and its agencies, showed that £39 million was spent in total, compared with £5 million the previous year.
Across the whole of the NHS, including the DoH, £153 million was spent on redundancies and “exits”, up from £141 million the year before.
Philip Dunne, the health minister, said that “voluntary exits” of DoH staff accounted for £31 million in a parliamentary answer published this week.

An additional £1.4 million was spent on compulsory redundancies, the Health Service Journal reported.

The remaining £6.6 million is thought to have been spent on voluntary redundancies at agencies including Public Health England and the Medicines and Healthcare Products Regulatory Agency. Ministers were criticised in March after revealing that 340 civil servants were to be recruited, despite the mass redundancies, largely to respond to Brexit.

Almost £2 billion had already been spent on NHS redundancies since 2010.

Official statistics released earlier this year showed that in the past three years more than 1,000 civil servants and senior NHS officials were awarded exit payments of more than £100,000, with 165 receiving at least £200,000.

Separate figures disclosed that more than 600 NHS quango bosses are now on six-figure salaries, with a doubling in the number earning more than the prime minister in just three years.

In 2010 the Conservatives pledged to reduce spending on NHS bureaucracy. A reorganisation of the health service reduced administrative costs, but has resulted in almost £2 billion being spent on redundancies.

The DoH said: “The department undertook a redesign and subsequent restructure to make sure it is best placed to meet current and future health and social care challenges. Redundancy and other departure costs were paid in accordance with the provisions of the civil service compensation scheme.”

Carolyn Wickware in Pulse 15th September reports: GPs told to refrain from referring as hospital declares early-season black alert

NHS managers still growing as GP posts fall

HSJ implies Managers and Directors are now at odds with Politicians over rationing..

It’s falling apart, and it’s going to get worse… for everyone except the top managers and politicians.

GPs (Commissioning Groups in England) spend vast sums on temporary managers – no its not happening in Scotland or Wales

NHS middle managers too comfortable to take top jobs “Kafkaesque regulation and rising patient expectations mean that managers and doctors opt for an easier life in less demanding roles”… political courage is needed.

Whistleblowing in the NHS – The need to regulate non-clinical hospital managers

Perverse behaviours by managers lead to covert and unfair systems for us all. Patients ‘bumped from cancer test waiting lists’

Trying to defuse some of the invective against NHS managers.


Deceitful verbal obfuscation. Prioritisation, limiting, restricting, reducing, cutting, delaying, (de-)commissioning: it’s all “rationing”

It is deceitful verbal obfuscation. Prioritisation, limiting, restricting, reducing, cutting, delaying: it’s all rationing and it needs to be discussed openly and honestly as such. Until it is the professions will remain disengaged. Since there is no honesty in our politicians, the response of the professionals in the UK’s 4 health services is entirely predictable. Meanwhile the disparity in services for the rich (private) and the poor (state) will become greater.

Paul Frances for Kentonline 14th September 2017 reports: West Kent Clinical Commissioning Group forced to cut services

An on-going cash squeeze on NHS budgets could see further restrictions on non-urgent operations and other treatments for patients in west Kent, it has emerged.

The West Kent Clinical Commissioning Group (WKCCG) says “significant cost savings” are needed to balance the books and rationing additional services will have to be considered.

Earlier this year, the CCG – which serves 463,000 people – delayed non-urgent operations for four months to save £3.2m, affecting 1,700 patients….

Dennis Campbell in the Guardian 12th September reports: NHS waiting times ‘driving people to turn to private treatment’Report says private providers have seen 15 to 25% annual rise in ‘self-payers’ as patients resort to using savings or loans

Chris Smyth in the Times 14th September reports: Elderly patients with broken hips wait too long for treatment

Four in ten elderly patients who break their hips suffer delays in vital treatment that increase their risk of ending up in a care home, a report says.
Seven patients a day also break their hips while in a hospital bed and the number appears to be rising, with some hospitals failing to do enough to keep patients safe, the study found.
Broken hips are a common injury among frail elderly patients and dealing with the aftermath is estimated to cost the health service £2 billion a year.
While death rates from the condition are falling, analysis of records of 65,000 patients, almost all those admitted to NHS hospitals over a year, found thousands not getting the care they should.
Almost one in ten patients were still immobile four months after an injury with “enormous variation” in rehabilitation rates at hospitals, the National Hip Fracture Database reported.

Patients are meant to get standardised care, most importantly surgery within 36 hours and a prompt review by a geriatrician. However, the review found 40 per cent of patients were not getting the treatments they should. “It’s truly terrible not to have early surgery. If you have to get on a bedpan with a broken hip there’s no dignified way of doing that and people just unravel,” Antony Johansen, clinical lead for the project, said.
“If 40 per cent of patients are not receiving this care — usually because they miss out on just one or two elements — this could compromise their rehabilitation and recovery.”
He said that while some hospitals had 80 per cent of patients back in their own homes a few months after injury, elsewhere it was “a tiny little number”. Hospitals are paid extra for good care and Dr Johansen said that there was no good reason for poor treatment.
“With care of frail older people, doing it well is cheaper than doing it badly. I know if I fail to rehabilitate someone and they go into a care home that’s a bill of £70,000 for them or the taxpayer.”
The audit also found that 4.1 per cent of all fractures happen while older people are in hospital, up from 3.9 per cent last year. Accidents peak during staff changeover times, it said.
“Seven people every day are breaking their hip in hospital and the slight trend for that to go up is concerning,” Dr Johansen said. “It’s something we need to challenge. It’s very easy not to have enough staff on the ward or have staff doing paperwork rather than being with patients.”
While saying that hospitals should not be overcautious and confine patients to bed, he said that some hospitals had only one fracture for each 700 beds each year, while others have as many as one for every 16 beds.
Patients in England are also spending a day longer in hospital than last year, at an average of 21 days.
Caroline Abrahams, of Age UK, said: “We are dismayed that 40 per cent of those who go under the knife don’t benefit from the best practice available. She added: “The numbers of hip fractures in hospitals are unacceptably high.”
• Elderly patients face becoming sicker if they are rushed out of hospital in an NHS drive to empty beds, say local councils. Simon Stevens, chief executive of NHS England, has given hospitals six weeks to free up thousands of places after saying flu was likely to hit the UK harder than usual. The Local Government Association said the plan would backfire as patients were taken back to hospital at the busiest times.

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Let us charge patients for extra services, GPs urge – is this “decommissioning”?

Cynical de-commissioning bringing back fear.. Dying patients waiting hours for pain relief in NHS funding shortfall.

We need to be talking de-commissioning and not commissioning….. Fewer doctors and higher occupancy mean more deaths – in Hospitals..

The Training of doctors…. unfortunately it is too late to recover in even the 5 years promised by government… Decommissioning of operations


West Wales Health has to have a future – somewhere in the “middle” ground… Back to 2006 and reversing the wrong decision taken then not to build a new Hospital.

Pembrokeshire and the Welsh health services are degenerating rapidly. In the Pembrokeshire Herald on September 1st 2017 Jon Coles writes  “Minister’s answer raises more Withybush questions. But it is the staffing crisis across the nation (see Times letters; page down) which is the issue, due to political denial and short termism. This is a template for the debates going on all around the country.

The article rightly points out the problems of recruitment and retention, but gives the impression that this problem could be solved locally. It is of course a National problem, of rationing of medical student capacity over decades, and of a gender bias towards female doctors, who work fewer life hours.  The gender bias is a result of undergraduate recruitment, and could be addresses by graduate recruitment. The problem of few applicants from rural schools and deprived areas needs to be addressed by adverse selection. State supported places at Medical School are a majority in the UK, but this is not the case abroad. So more and more determined applicants who are rejected may choose to train in Prague or in Malta. This is a National Problem and the “rules of the game” mean Hywel Dda is going to fail. To attract medical staff for the next decade areas such as Pembrokeshire need to combine resources with surrounding areas, and have high tech cold surgical units in their centre. 

The “middle” ground is around Whitland or St Clears. Funny than was mentioned some time ago…

Katy Woodhouse in the Western Telegraph writes: Last chance to have a say on health services changes 

As if the Trust are going to take any notice. Utilitarian decisions taken for the people of West Wales mean that each District General Hospital will lose a little, but the overall result could be better eventually, provided there is adequate funding and the longer term rationing of medical student and nursing places is corrected. Do attend the last meeting in Pembroke Dock on Friday 15th September, and then reflect in a decades’ time… Kate implies that the Trust are reconsidering the plans of 10 years ago!

IT may feel like deja vu but the idea of a new hospital between Haverfordwest and Carmarthen has been raised again, over ten years since it was suggested by the then health board.

As Hywel Dda Health Board prepares to make more changes to services in the area – stating that changes need to be made – residents are being urged to have their say.

The current consultation on ‘transforming services’ and mental health provision are drawing to a close and Hywel Dda state there have been a number of surprising suggestions made by those who have already taken part.

“I’d like to thank everyone so far who has taken the time to attend an event, write us a letter or fill in our survey. We understand that this may not be a new message to most, that you may have heard us say many times in the past that the NHS needs to change. But what is different this time is that we have our doctors and services telling us that if things don’t change, our money and the time and expertise of our staff will be spent on simply maintaining the same services and plugging gaps.
“In the field of medicine we should be investing in new ways of working, modern buildings and giving our staff the time to change the way they work for the benefit of their patients. It is time to move forward and no longer stand still.
“So I’d like to formally invite any Pembrokeshire residents who haven’t yet shared their thoughts to come to Pater Hall and make their voices heard. Now is the time for people to speak up and share their ideas and experiences to help make the NHS in mid and west Wales the best it can be.”


Sir, Most people realise that there is a looming crisis in the NHS because of the growing shortage of capable and qualified people available to work in it at all levels. It is perhaps less well understood that this manpower shortage will be greatly exacerbated by the impact of Brexit. If solid reassurances are not forthcoming in the near future, there is a real risk that the quality of the service people expect from the NHS will deteriorate. We are already seeing staff who are EU citizens leaving the NHS or seriously considering their options for the future. This should concern us all.

While I acknowledge the complexities of negotiating with EU officials representing the interests of 27 other member states, and the need to seek guarantees for UK citizens in living and working in Europe, surely the prime minister and her ministerial team could do more now to assuage the fears of our EU colleagues.

If nothing is done now, then we face the very real threat of highly qualified and valued members of staff leaving in ever greater numbers in a relatively short period of time. Nobody should underestimate the dire consequences if and when this scenario becomes a reality over the coming months.
Tim Melville-Ross

Chairman, Homerton University Hospital NHS Trust, and former director-general, Institute of Directors

Breaks Ranks 24052006

Rationed to dangerously low levels – “..Nine in 10 of the biggest NHS trusts are below safe staffing levels”.

The collusion of denial of rationing by politicians and administrators continues. Caroline Wheeler reports in The Sunday Times 13th August 2017: Nurse numbers dangerously low – Nine in 10 of the biggest NHS trusts are below safe staffing levels

This is the result of rationing places in nursing to save costs over a short time horizon (4 years or one term of office). The longer term loss of money due to inefficiencies and diminishing standards does not concern today’s politicians. In my own constituency the MP won by a few hundred votes, and is likely to lose the seat next time. An “honest debate” is what the public wants, but all parties are denying them… It does not help that Nurses are “graduates” as the caring side of personal care is excluded from their jobs as they get more senior. And now we are threatened with fewer immigrant nurses…So, it’s going to get worse.

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Nearly all England’s 50 biggest hospital trusts are failing to hire enough nurses to ensure patients are safe.
Nine in 10 of the trusts, which oversee 150 hospital sites, are not meeting their own safe staffing targets, according to analysis by the Royal College of Nursing (RCN).
The data also suggest nurses are being increasingly replaced by cheaper, unqualified healthcare assistants.
To cope with the shortage of nurses, more than half the largest hospitals (55%) brought more unregistered support staff onto shifts, the figures show. The situation is worse at night, with two thirds (67%) of hospitals using unregistered support staff — which critics claim will lead to higher patient mortality rates.
Janet Davies, chief executive and general secretary of the RCN, said patients can pay the “very highest price when the government encourages nursing on the cheap”.

She added: “Nurses have degrees and expert training and, to be blunt, the evidence shows patients stand a better chance of survival and recovery when there are more of them on the ward.”
A separate study of staffing in NHS hospitals, published in the online journal BMJ Open, found that in trusts where registered nurses had six or fewer patients to care for, the death rate was 20% lower than where they had more than 10.
Hospitals have had to publish staffing levels since April 2014 in response to the scandal at Stafford Hospital, where hundreds died from neglect.
The RCN analysis, which calculates the average fill-rate across the month, reveals the worst affected site was the Royal Blackburn Hospital, which had on duty only three quarters of the nurses needed.
According to the RCN there are 40,000 nurse vacancies. Brexit, low morale, the end of bursaries for tuition fees, and the public sector pay freeze have all been blamed.

The Department of Health said: “Just this month we announced an extra 10,000 places for nurses, midwives and allied health professionals by 2020, and there are over 12,500 more nurses on our wards since 2010.”

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Comments are legion at the Sunday Times. Here is one..

Stephen G Spencer letter by e-mail

With the culture of bullying so prevalent, pay held so that salaries today are worth less but nurses expenses like others have gone up, and a plainly mad Secretary of State and Department of Health that thought doing away with nurses training bursaries was a good idea, together with all those nurses from EU countries worried about the implications of Brexit for them and their families. No surprise at all. But quite worrying if you do have to go into hospital.

NHS must cut waste if it wants more cash and NHS “must put it’s house in order before demanding more cash”.

It’s going to get worse though, despite this report. When the professor writes a report without mentioning rationing we know what will happen to it… Writing a report from the provider side will only emphasise that it is not “patient centred”, but government centred. The bureaucracy is unable to change without the rules of the game being changed.. Mental health is a case in point, where desperation has led to a promise of more money, but what will suffer as a result?

(Judge warns of ‘blood on our hands’ if suicidal girl is forced out of secure care


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Chris Smyth in the Times 4th August reports: NHS must cut waste if it wants more cash

The NHS does not deserve more money because it wastes so much on poor care, according to the senior surgeon who has the job of driving up standards.
The health service must put its house in order before asking for extra taxpayers’ cash, said Tim Briggs, who is conducting the most comprehensive clinical efficiency audit of the NHS yet undertaken.
His review found huge variations in the cost and quality of common treatments, with low-performing hospitals routinely ignorant about superior methods adopted elsewhere.
The NHS could save hundreds of millions, if not billions, a year if the best and most efficient practices were applied across the country, Professor Briggs concluded.
His programme is backed by the health secretary, Jeremy Hunt, who urged hospitals yesterday to act on the findings, as well as Simon Stevens, the head of NHS England……

Specialists in each area gather data from hospitals then sit down and discuss individual results with clinical staff in each unit, learning from the best and helping poor performers improve. “Just putting it in a drawer and forgetting about it is no longer an option,” he said.

Profile: Tim Briggs
After a long and distinguished career as a hip and knee surgeon, Tim Briggs admits that he is out of his comfort zone as a crusader for NHS clinical efficiency (Chris Smyth writes).

Yet the former Blackheath rugby forward does not flinch from tackling colleagues.

A consultant at the Royal National Orthopaedic Hospital since 1992, Professor Briggs grew used to seeing patients with complications caused by botched surgery. It was obvious not everywhere was doing as well as they could.

In 2012 as the president-elect of the British Orthopaedic Association, he gathered data on all orthopaedic units, visiting them to discuss their results. It is this, he insists, that makes the “getting it right first time” programme different from the plethora of audits the NHS has seen come and go.

Times leader: Healing the healers.

The British love the National Health Service, but it is in a mess. It was built in the 1940s for a different kind of country. Now it largely looks after a bulging population of the old and chronically ill, and is constantly short of cash. Reform is urgently needed but it has been too slow to arrive. A troubling new report is likely to drive this point home to doctors and health officials. It was overseen by a respected and straight-talking orthopaedic surgeon, Tim Briggs, and was backed by the health secretary, Jeremy Hunt. The report, on general surgery, part of a much broader review led by Professor Briggs, finds the NHS is wasting a great deal of money.

It says that 300,000 patients a year are needlessly admitted for emergency operations, and £23 million wasted on patients staying too long in hospital after bowel surgery. Some hospitals are paying much more than others for surgical supplies, and varying infection rates for hip replacements (between 0.2 per cent and 5 per cent, depending on where people go) cost the heath service £300 million. Hospitals tend to have no idea what others are doing and are surprised when told that they are behind their peers. In sum, Professor Briggs told The Times: “I do not think at the moment we deserve more money until we put our house in order.”

This argument has some merit. Professor Briggs’s report is the latest in a line of government reviews which have pointed out that there is money down the back of the sofa. In 2014 the NHS England chief’s Five Year Forward View found room in the health service for £22 billion in efficiency savings by 2020. In his 2015 report the former Marks and Spencer boss Lord Rose of Monewden concluded that the health service was “drowning in bureaucracy”. And last year a report by Lord Carter of Coles said that hospitals were wasting £5 billion on paying too much for supplies.

The NHS response has been glacial or nonexistent. But its problems are not unsolvable and it has a number of correctable design flaws. There is political pressure not to run deficits but little to invest in innovations, which means that smart new ideas do not often travel from one hospital to another. Hospitals are paid per operation so they are not inclined to cut back. Separate budgets and commissioners for different sections of the NHS (such as preventive healthcare and specialist hospital care) mean ideas that might move money from one to another are often resisted. No single person holds responsibility for smoothing out variations across the health service. The matter can therefore slip under the radar.

Any changes will require considerable political clout. The Department of Health has yet to recover fully after the botched reforms under Andrew Lansley, Mr Hunt’s predecessor. While other public services such as the police have spruced up their technology and adapted to changing needs, the NHS has remained in deep freeze. It should summon the confidence to drive through the reforms that a modern health service urgently needs.Professor Briggs’s project suggests that matters may be moving in the right direction. It is not just a data-gathering exercise — his team take their results from hospital to hospital, talking through how each health centre compares with its peers. Professor Briggs claims that a similar initiative from 2012, on orthopaedics, is now yielding good results.
The health service is not alone in its problems. It shares them with most of the world’s healthcare systems. This year’s Commonwealth Fund survey found Britain’s health service to be the best, safest and most affordable of the 11 countries that it analysed. The NHS is also one of the biggest organisations on the planet. The pace of change, however, need not be so languid. Certainly it will continue to require more cash, but first it must show that it can spend that cash wisely and efficiently.

Changing the rules of the game

Who will be the “last man standing” in your practice? Changing the rules of the game

NHS funding advice: GDP worth debating… Showers of money will not work..

When will public anger over the NHS reach a political tipping point? More NHS mental health patients treated privately…

in 1983 another eminent Orthopaedic Professor reported: His advice was taken at first, fond to be more expensive and then ignored. Orthopaedic waiting lists: time for more, and equal access to, non-urgent centres The difference between Hospital Infection rates is nothing when private hospitals are added to the mix. Instead of a 50 fold difference in infection there is a 500 fold difference in risk of infection.


Doctors attack plan to close children’s heart unit at the Royal Brompton hospital. Can 216 specialists be wrong?

Chris Smyth reports in the Times 28th July 2017: Doctors attack plan to close children’s heart unit at the Royal Brompton hospital

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Doctors from around the world have condemned plans to close the biggest NHS children’s (The Brompton) heart surgery unit, in a battle that highlights how the NHS struggles to make life-saving reforms.

Thousands of children would suffer if the Royal Brompton’s congenital heart disease unit was closed and care for adults would also be put at risk, according to 216 specialists in cardiology and paediatrics.

NHS England said last year that the unit was one of three hospitals that must no longer operate on children or adults with inherited heart problems in an attempt to improve standards by centralising care.

The move dates back to the Bristol heart scandal in the 1990s and the principle of restricting complex care to a smaller number of specialist centres is widely supported. However, disputes about the evidence and which units should close have derailed such plans.

In a letter to The Times, doctors say that the Brompton’s results are excellent and “it is difficult to identify where any patient benefit would accrue” by closing the unit.

NHS England said: “We all want to ensure that patient care is as good as it can possibly be.”

Letters to the Times 28th July 2017:


Sir, As medical professionals working in cardiovascular, respiratory and paediatric care, we urge the health secretary to block plans to decommission congenital heart disease (CHD) services at Royal Brompton Hospital. This plan would affect more than 14,000 patients and 400 staff and would cost tens of millions of pounds, yet it is difficult to identify where any patient benefit would accrue. Official data show that Royal Brompton’s CHD service is the largest in the UK, with excellent patient outcomes. The Royal Brompton & Harefield NHS Foundation Trust’s adult CHD research team is independently rated as the most influential in the world.

NHS England’s plan will result in the closure of Royal Brompton’s paediatric intensive care unit (PICU), losing a sixth of London’s PICU beds at a time when there is already a widely publicised shortage in London and the south. The lack of a PICU would in turn occasion the loss of other heart and lung services treating thousands of patients, including the country’s largest paediatric cystic fibrosis and difficult asthma services.

Dr David Ross, Consultant Paediatric Cardiac Surgeon, University of Alberta Hospital; Dr Gary Webb, Consultant Cardiologist, Cincinnati Children’s Hospital; Professor Ju Le Tan, Senior Cardiology Consultant, National Heart Centre Singapore; Professor Paul Khairy, Director, Adult Congenital Heart Centre, Montreal Heart Institute; Professor Tal Geva, Professor of Paediatrics, Boston Children’s Hospital / Harvard Medical School; Dr Lisa Hornberger, Professor of Paediatrics and Consultant Cardiologist, University of Alberta / Stollery Children’s Hospital; Professor Barbara Mulder, Cardiologist, Academic Medical Centre Amsterdam; Dr Susan Etheridge, Professor of Paediatrics, University of Utah; Professor Jolien Roos-Hesselink, Consultant Cardiologist, Erasmus Medical Center Rotterdam; Professor Dipen Shah, Director, Cardiac EP, University Hospitals Geneva; Professor Wayne Tworetzky, Consultant Attending, Boston Children’s Hospital; Dr Puja Banka, Consultant Cardiologist, Boston Children’s Hospital; Dr Anne Marie Valente, Cardiologist, Boston Children’s Hospital; Dr Andrew Powell, Chief, Cardiac Imaging Division, Boston Children’s Hospital; Dr Alexander Opotowsky, Assistant Professor, Boston Children’s Hospital / Brigham and Women’s Hospital / Harvard Medical School; Professor Douglas L. Packer, Director Translational Electrophysiology / Clinical Consultant Electrophysiology, Mayo Clinic / Mayo Foundation; Professor Luc Mertens, Consultant Cardiologist, The Hospital for Sick Children, Toronto; Professor Edgar Jaeggi, Director, Fetal Cardiac Program, The Hospital for Sick Children, Toronto; Dr Elizabeth Stephenson, Consultant Cardiologist, The Hospital for Sick Children, Toronto; Professor Vivek Reddy, Director of Electrophysiology, Mount Sinai Hospital, New York; Professor Mats Mellander, Consultant Paediatric Cardiologist, Queen Silvia Children’s Hospital, Sweden; Dr Vasu Venkanna Burli, Clinical Fellow Children’s Acute Transport Service, Great Ormond Street Hospital; Dr Evangelia Papathanasiou, Clinical Fellow in Paediatric Cardiology, Great Ormond Street Hospital; Professor Peter Schwartz, Director, Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano; Dr Riyan Sukumar Shetty, Consultant Paediatric ITU and Head of ECLS, Narayana Institute of Cardiac Sciences, India; Dr Aranzazu Gonzalez Posada, PICU Consultant, 12 de Octubre Hospital, Madrid; Mr Michael Heuer, Managing Director Europe, Acutus Medical, Belgium; Dr Kelly Straka, PICU Fellow, Aghia Sophia Children’s Hospital, Greece; Professor George Giannakoulas, Consultant Cardiologist, AHEPA University Hospital, Greece; Dr Fulvio Gabbarini, Consultant Cardiologist & Chief of Grown Up Congenital Heart Center, AOU Città della Salute e della Scienza di Torino, Turin University; Dr Sumanaru Dorin, Paediatrics, AP-HP Paris; Dr Prabhat Maheshwari, Head of Paediatric Intensive Care, Artemis Hospital, Gurgaon, India; Professor Karl-Heinz Kuck, Head of Cardiology Dept., Asklepios Klinik St. Georg, Germany; Dr Michael Schlüter, Scientist, Asklepios Proreseach, Germany; Dr Hani Mahmoud, Associate Consultant Cardiologist, Aswan Heart Centre, Egypt; Dr Massimo Stefano Silvetti, Cardiologist, Bambino Gesù Children’s Hospital, Rome; Dr Fabrizio Drago, Paediatric Cardiologist & Chief of Paediatric Cardiology, Bambino Gesù Children’s Hospital, Rome; Dr Ramaratnam Ramanan, Consultant Paediatrician, Basildon Hospital; Dr Tosin Otunla, Consultant Paediatrician, Ashford & St Peter’s Hospital; Dr Anita Mittal, Consultant Paediatrician, Bedford Hospital; Mr Nimrod Hershco, Field Clinical Specialist, Belinson, Israel; Professor Cristiane Martins, Consultant Cardiologist, Biocos Hospital, Brazil; Mr Bjarne Larsen, Clinical Development Manager, Biosense Webster, Denmark; Dr Farhana Khalil, Consultant Paediatrician, Bradford Teaching Hospitals; Dr Martin Hosking, Consultant Cardiologist, British Columbia Children’s Hospital; Dr Raghavan Nair Mahesh Babu, Consultant Paediatrician, Broomfield Hospital; Mr Lars Retzlaff, Senior Field Clinical Specialist, Bsc, Germany; Professor Jia L, Professor, Capital Institute of Paediatrics, China; Dr Jelena Radojevic Liegeois, Paediatric and Adult Congenital Cardiologist, Strasbourg; Dr Junaid Zaman, Electrophysiologist, Cedars Sinai Medical Center, US; Dr Joachim Hebe, Co-Chair, Center for Electrophysiology Bremen, Germany; Professor Christos Ouzounis, formerly Professor & Chair, King’s College London, CERTH, Greece; Professor Stefan Willich, Director, Charite University Medical Center, Germany; Dr Sam Kaddoura, Consultant Cardiologist, Chelsea and Westminster Hospital; Dr Bikash Bhojnagarwala, Consultant Neonatolgist, Chelsea and Westminster Hospital; Dr Jonathan Penny, Consultant Paediatrician, Chelsea and Westminster Hospital; Dr Martin Stocker, Consultant PICU/NICU, Children’s Hospital Lucerne, Switzerland; Dr Jose Pedro Da Silva, Peadiatric Cardiothoracic Surgeon (Attending), Children’s Hospital of Pittsburgh of UPMC; Professor Gil Wernovsky, Senior Consultant in Paediatric Cardiology and Cardiac Critical Care, Children’s National Health System, US; Dr Marie Bosman, Consultant Anaesthetist, Christian Barnard Mem Hospital, South Africa; Dr Marko Gujic, Consultant Electrophysiologist, CHU Charleroi, Belgium; Professor Julian Villacastin, Director Cardiovascular Institute, Clínico San Carlos. Madrid, Spain; Dr Radu Vatasescu, Consultant Cardiologist, Head EP Lab, Clinic Emergency Hospital Bucharest; Dr Miguel Ventura, Cardiologist Electrophysiologist, Coimbra University Hospital, Portugal; Dr Theo Fenton, Consultant Paediatrician, Croydon University Hospital; Dr Dinakaran Rengan, Consultant Paediatrician, Croydon University Hospital; Dr Nazma Chowdhury, Consultant Paediatrician , Croydon University Hospital; Professor Hans-Heiner Kramer, Director, Department of Congenital Heart Disease and Paediatric Cardiology, Kiel; Professor Annalisa Angelini, Associate Professor of Cardiovascular Pathology, University of Padua, Italy; Professor Ingo Daehnert, Head of Paediatric Cardiology, Heart Center, University of Leipzig; Professor Gaetano Thiene, Professor of Cardiovascular Pathology, Università degli Studi di Padova, Italy; Dr Alexandra Galloway, Consultant Paediatrician, East and North Hertfordshire NHS Trust; Miss Elia Heraclio Doya, Internist and Cardiologist, Ernst von Bergmann Klinikum, Germany; Dr Judit Llevadias, Paediatric Cardiac Intensive Care Consultant, Freeman Hospital, Newcastle; Professor Jochen Weil, Consultant Paediatric Cardiologist, German Heart Center Munich; Professor Isabel Deisenhofer, Head of Department, German Heart Center Munich; Professor Gabriele Hessling, Consultant Paediatric Cardiologist, German Heart Center Munich; Dr Oktay Tutarel, Consultant Cardiologist, German Heart Centre Munich; Mrs Jenni Syrjaenen, Clinic Manager, German Heart Centre, United Arab Emirates; Professor Christof Stamm, Consultant Surgeon, German Heart Institute Berlin / Charite Universitaetsmedizin; Mrs Miriam García San Prudencio, Consultant Paediatrician, Gregorio Marañón Hospital, Spain; Professor Yves Ville, Professor of Obstetrics and Fetal Medicine, Hôpital Necker Enfants Malades, France; Professor Simcha Yagel, Consultant Obstetrician/Gynecologist, Hadassah-Hebrew University Medical Center, Israel; Dr Roman Gebauer, Consultant Paediatric Cardiologist, Heart Centre, University of Leipzig; Dr Fernando Moraes, Consultant Cardiac Surgeon, Heart Institute of Pernambuco, Brazil; Dr Britta Weidtmann, Consultant Cardiologist, Helios Berlin; Dr Michele Cruwys, Consultant Paediatrician, Hillingdon Hospital; Professor Mélèze Hocini, Consultant Cardiologist, Hopital Haut Leveque, France; Dr Elena Montañes, Consultant Cardiologist, Hospital 12 Octubre, Madrid; Ms Rosa Maria Calderon Checa, Consultant PICU, Hospital 12 Octubre, Madrid; Professor Cleonice de Carvalho Mota, Consultant Paediatric Cardiologist, Hospital das Clínicas/ Federal University of Minas Gerais, Brazil; Dr Patrícia Barrios, Consultant Paediatric Cardiologist, Hospital de Clínicas de Porto Alegre (UFRGS), Brazil; Dr María del Carmen Gutiérrez, Paediatric Pathologist, Hospital Pereira Rossell / University of Uruguay; Dr Joaquim Bartrons Casas, Consultant Fetal and Paediatric Cardiologist, Hospital Sant Joan de Deu, Spain; Professor Jose Luis Merino, Chief Robotic EP Laboratory, Hospital Universitario La Paz, Spain; Mrs Ana María Marcos Oltra , PICU Consultant, Hospital Virgen de la Arrixaca, Murcia, Spain; Professor Josef Kautzner, Head of Department, IKEM, Czech Republic; Dr David Inwald, Consultant Paediatrician with Expertise in Cardiology, Imperial College Healthcare NHS Trust; Dr Jayanta Banerjee, Consultant Neonatologist, Hon Consultant, Paediatric Cardiology, Hon Senior Clinical Lecturer, Imperial College Healthcare NHS Trust / Imperial College London; Dr Aubrey Cunnington, Clinical Senior Lecturer in Paediatric Infectious Diseases, Imperial College London; Dr William Aaron Kay, Medical Director, Adult Congenital Cardiology Program, Indiana University; Miss Renate Oberhoffer, Director, Institute of Preventive Paediatrics, Technical University Munich; Professor Carina Blomström Lundqvist, Consultant Cardiologist, Institution of Medical Science, Sweden; Dr Raul I. Rossi Filho, Consultant Pediátrica Cardiologist, Instituto de Cardiologia, Brazil; Dr Estela Suzana Horowitz, Consultant Cardiologist, Instituto de Cardiologia, Brazil; Professor Vera Aiello, Cardiovascular Pathologist, Instituto do Coracao (InCor), Faculdade de Medicina da Universidade de Sao Paulo; Professor Peter Schwartz, Director, Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Italy; Dr Koby Sheffy, Chief Scientist, Itamar Medical, Israel; Professor Cecilia Linde, Consultant Cardiologist, Karolinska University Hospital, Sweden; Dr Haitham Sakr, Consultant Cardiologist, King Saud Medical City, Saudi Arabia; Dr Spyridon Zidros, Echocardiography Fellow, King’s College Hospital; Dr Philip Knight, PICU fellow, King’s College Hospital; Dr Laura Vitali Serdoz, Head of the Arrhythmia and Electrophysiology, Klinikum Fuerth, Germany; Professor Alpay Celiker, Consultant Cardiologist, Koc University Hospital, Turkey; Dr Akiko Ueda, Cardiologist, Kyorin University Hospital, Japan; Dr Hamish Walker, Consultant Cardiologist, Leeds General Infirmary; Professor Katja Zeppenfeld, Prof. Cardiology, Leiden University Medical Centre, Netherlands; Dr Lyn Ventilacion, Consultant Paediatrician, Lister Hospital; Dr Jan Reiser, Consultant Paediatrician, Lister Hospital; Dr Prathiba Chandershekar, Consultant Neonatal Paediatrician, Lister Hospital; Dr Kanimozhi Tamilselvan, Consultant Paediatrician, Lister Hospital; Dr Anshoo Dhelaria, Paediatric Consultant, Lister Hospital; Dr Sharmishtha Sarkar, Consultant Community Paediatrician, Lister Hospital; Dr Amanda Williams, Consultant Paediatrician, London North West Healthcare NHS Trust; Dr Khadija Ben-Sasi, Consultant Neonatologist, London North West Healthcare NHS Trust; Dr Wolfgang Muller, Consultant Paediatrician, London North West Healthcare NHS Trust; Dr Gerald Hanson, Consultant Paediatrician with cardiology expertise, London North West Healthcare NHS Trust; Dr Nilanjana Ray, Consultant Paediatrician, London North west Hospitals NHS Trust; Dr Krishnan Balasubramanian, Consultant Paediatrician, Maidstone and Tunbridge Wells NHS Trust; Dr Burkhard Hügl, Chief of Cardiology Department, Marienhaus Neuwied, Germany; Dr Job Cyriac, Paediatric Consultant with Cardiology Interest, Mid Essex Hospitals NHS Trust; Dr Michele D’Alto, Consultant Cardiologist, Monaldi Hospital, Italy; Dr Ali Zaidi, Director of Adult Congenital Heart Disease Program, Montefiore Medical Center, Albert Einstein College of Medicine, US; Dr Peter G. Guerra, Chief of Medicine and Cardiology, Philippa and Marvin Carsley Chair in Cardiology, Montreal Heart Institute; Professor Jan Janousek, Consultant Paediatric Cardiologist, Motol University Hospital, Czech Republic; Dr Mithuna Urs, Consultant Paediatrician, Maidstone and Tunbridge Wells NHS Trust; Dr Shreesha Maiya, Consultant Paediatric Cardiologist and Electrophysiologist, Narayana Health, India; Dr Ganesh Sambandamoorthy, Consultant CICU , Narayana Institute of Cardiac Sciences, India; Professor Marek Malik, Professor of Cardiac Electrophysiology, National Heart and Lung Institute, UK; Dr Alice Maltret, Paediatric Cardiologist, Necker-Enfants Malades, France; Dr Barbara Deal, Consulting Cardiologist, Northwestern Hospital, US; Dr Kerry Day, Consultant Paediatrician, Northwick Park Hospital; Dr Sheana Wijemanne, Paediatric Consultant, Northwick Park Hospital; Dr Richard Nicholl, Consultant Paediatrician, Northwick Park Hospital; Dr Thais Lins Pedersen, Resident Cardiologist, Odense University Hospital; Dr Tom De Potter, Staff Cardiologist, OLV Hospital, Belgium; Professor Seshadri Balaji, Paediatric Cardiology, Oregon Health & Science University; Dr Craig Broberg, Consultant Cardiologist, Associate Professor, Oregon Health and Science University; Miss Silvia Scansani, Cardiac Physiologist Echo, Policlinico Ospedale Maggiore, Italy; Dr Deane Yim, Consultant Paediatric Cardiologist, Princess Margaret Hospital Perth; Dr Catarina Cavalcanti, Paediatric Cardiologist, PROCAPE University Hospital / University of Pernambuco, Brazil; Dr Monther Obeidat, Fellow in Paediatric Cardiology, Queen Alia Heart Institute, Jordan; Professor Stephanie Ware, Professor of Paediatrics and Medical and Molecular Genetics, Riley Hospital for Children at Indiana University; Professor Yves d’Udekem, Consultant Cardiac Surgeon, Royal Children’s Hospital, Australia; Dr Sainath Raman, Paediatric Intensive Care Fellow, Royal Children’s Hospital, Australia; Dr Safeena Afzal, Anaesthetic Registrar, Royal Free Hospital; Dr Ana Martinez Naharro, Clinical Research Fellow, Royal Free Hospital; Dr Mark Spence, Consultant Cardiologist, Royal Victoria Hospital; Dr Mariutzka Zadinello, Consultant Paediatric Cardiologist, Saúde Santa Mônica Medical Center, Brazil; Dr Fredy Prada, Consultant Cardiologist, Sant Joan de Deu Hospital, Spain; Dr Amish Vora, Senior Consultant Paediatric Intensivist, SRCC NH Children’s Hospital, India; Dr Sandeep Shetty, Consultant Neonatologist, St George’s University Hospital NHS Foundation Trust, UK; Dr Donovan Duffy, Consultant Neonatologist, St George’s University Hospital NHS Foundation Trust, UK; Dr Nasreen Aziz, Consultant Neonatologist, St George’s University Hospital NHS Foundation Trust, UK; Dr Cliona Murphy, Consultant Cardiologist and Electrophysiologist, St Luke’s Hospital, University of Missouri Kansas City, UK; Dr Alison Groves, Consultant Paediatrician & Cardiology Lead, St Peter’s Hospital, UK; Dr Anay Kulkarni, Consultant Neonatologist, St George’s University Hospital NHS Foundation Trust, UK; Dr Maxim Didenko, Head of Department, Associate Professor, St. Petersburg Paediatric State University, Russia; Professor Sanjiv Narayan, Professor of Medicine, Stanford University, Palo Alto, California, US; Dr Venkata Krishna Kishore Jayanthi, Consultant Paediatric Intensivist, Star Hospital, India; Professor Evgeny Pokushalov, Head of Arrhythmia Department and Electrophysiology Laboratory, State Research Institute of Circulation Pathology, Russia; Mr Bart Wittevrongel, Director Clinical Adoption EMEA & ROW, Stereotaxis, Belgium; Ms Dustie Butteiger, Research and Clinical Affairs Manager, Stereotaxis Inc., US; Dr Paul Brathwaite, Vice President of Research and Development, Stereotaxis, Inc., US; Mr Nathan Kastelein, Medical Systems Engineer, Stereotaxis, Inc., US; Dr Adil Dingankar, Cardiac Critical Care Research Fellow, Stollery Children’s Hospital, Canada; Dr Claire Scudder, GP, The Chelsea Practice, UK; Professor Jack Rychik, Robert and Dolores Harrington Endowed Chair in Paediatric Cardiology, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine; Dr Andrew Davis, Paediatric Cardiologist and Electrophysiologist, The Royal Children’s Hospital, Australia; Dr Daniel Tobler, Staff Cardiologist, University Hospital Basel, Switzerland; Dr Ans Wiesfeld, Cardiologist / Electrophysiologist, University Hospital Groningen, Netherlands; Professor Gerhard-Paul Diller, Consultant Cardiologist, University Hospital of Münster, Germany; Dr Maria Grazia Bongiorni, Director of Cardiology Department, University Hospital of Pisa; Dr Matthias Greutmann, Director Congenital Heart Disease Unit, University Hospital Zurich; Dr Fernando Amaral, Consultant Adult Congenital Heart Disease, University Hospital, Ribeirão Preto, Brazil; Dr Mohammad Zoha, Consultant Paediatric Transport, University Hospitals of Leicester; Dr Julia Vujcikova, Consultant Paediatric Intensivist, University Hospitals of Leicester; Professor Isabelle Van Gelder, Cardiologist, University Medical Center Groningen, Netherlands; Professor Ian Adatia, Consultant Paediatric Pulmonary Hypertension Specialist and Paediatric Cardiologist, University of Alberta / Stollery Children’s Hospital / Glenwood Paediatric Cardiology Clinic, Canada; Dr Julia Indik, Professor of Medicine, Division of Cardiology, University of Arizona, Sarver Heart Center, US; Professor Nassir Marrouche, Professor of Medicine, University of Utah; Professor Jeanne Poole, Consultant Cardiologist-Electrophysiologist, University of Washington; Professor Haran Burri, Staff Physician, University Hospital of Geneva; Dr Ferran Rosés-Noguer, Lead of Paediatric Cardiology Department, Vall d’Hebron University Hospital, Spain; Dr Sunil Raga, Consultant Paediatrician; Professor David L Wessel, Executive Vice President and Chief Medical Officer, Washington; Dr Sankara Narayanan, Paediatrician with Cardiology Interest, Watford General Hospital; Dr Emmanuel Quist-Therson, Consultant Paediatrician/Local PEC, West Hertfordshire Hospitals NHS Trust; Dr Eleanor Hulse, Consultant Paediatrician, West Middlesex University Hospital; Trudie Lobban MBE FRCP (Edin), Expert Patient Representative, Arrhythmia Alliance, UK; Dr Anil Garg, Consultant Paediatrician – PECSIG, Western Sussex Hospitals Foundation NHS Trust; Dr Anna Mathew, Consultant Paediatrician, Western Sussex Hospitals NHS Foundation Trust; Dr Jonathan Mervis, Consultant Paediatric and Interventional Cardiologist, Westmead Children’s Hospital, Australia; Dr Rachael Cordina, Cardiologist, Royal Prince Alfred Hospital, Clinical Senior Lecturer, University of Sydney; Dr Coralie Blanche, Hôpitaux Universitaires de Genève; Dr Riikka Rydman, Karolinska Institutet, Sweden; Dr Annette Schophuus Jensen, Department of Cardiology, Rigshospitalet, Copenhagen; Professor Alex Davidson, Cardiologist, Children’s Hospital of Philadelphia; Mrs Maria Cristina Bembom, Consultant Cardiologist, Hospital de Clinicas Gaspar Vianna, Brazil; Professor Maiy El Sayed, Consultant Paediatric and Adult Congenital Cardiologist, Ain Shams University Hospitals, Egypt; Professor Lars Sondergaard, Consultant Cardiologist, Rigshospitalet, Denmark; Professor Paul Volders, Cardiologist / Professor of Genetic Cardiology, Maastricht University Medical Centre; Mr Charles E. Juvin, Cardiovascular Surgeon, Hôpital Universitaire Pitié-Salpêtrière, France; Professor William Yip, Adjunct Professor, National University of Singapore; Dr Trong Phi Le, Klinikum Links der Weser, Germany; Dr Tiffany Ng, Junior Doctor, Chelsea and Westminster Hospital

Peers from across political spectrum unite to support our CHD service

Thousands march to save Royal Brompton services from closure … (March 2017)

and The Guardian: Why is this children’s heart unit facing closure? A day on the NHS …Jessica Elgot

For our last appointment of the day, we meet Robert Craig, the chief operating officer at Royal Brompton. NHS England’s plans to close the unit might be emotionally distressing for staff and patients, but if giving other hospitals more consultants, doing regular complex work in bigger hospitals and closing smaller ones improves outcomes, isn’t that the best way to “future-proof” the NHS?

Craig firmly disagrees with that proposition. Instead, he says he believes there are clear-headed clinical arguments against closure.

Yes it’s an emotional, almost visceral thing for people who work here,” he says. “It was the first adult congenital unit in the country; it’s one of the biggest in the country; our outcomes are among the best and they compare well with the rest of the world. But no, it isn’t just an emotional issue. It’s a logical, clinical question too. Why seek to fragment the biggest centre in the country?”
The Guardian asked Craig to read arguments made earlier on the blog by Prof Huon Gray, the NHS national clinical director for heart disease – and respond directly to his case forclosing the unit.

NHS surgeons … must perform between them at least 500 operations a year, which is about three each every week. That is a minimum.”

.We absolutely agree with that, we do more than the standards require,” says Craig.
“There is an argument being made that small, specialist hospitals are outdated. The argument I always make is that there used to be a hospital specifically for skin diseases, which got taken over by St Thomas’s and became a dermatology ward. And we don’t yet have a cure for psoriasis. I’m not saying that’s cause and effect, but I don’t know if something might have been different if we still had a specialist skin hospital. Because you lose the focus that clinicians can identify. Our services are different to the cardiac wards at Hammersmith or or St George’s hospital.

Their services, as judged by mortality data, are safe … [But] that is a different argument from saying do we think in the future we could do better when children are born with a complex cardiac disease where treatment previously would not have been thought feasible?

Craig says things are already improving. “The number of people now surviving through to adulthood is vastly more than 20 years ago,” he said.

“The challenge now is thinking of this as a predominantly adult service to manage, because of survival rates. And we’re in the perfect position to do that. We see people transition through. There is a risk as a teenager, and frankly getting fed up with treatment plans and hospitals. And at that exact moment, they have to be taken away from the team they’ve known all their lives to a new adult hospital. Lots of US evidence suggests that people get lost to follow-up, and our setup enables that to be much rarer.”

Co-location is Gray and NHS England’s key argument:

If I were a parent sitting beside the bed with a child who needed other specialist input, I would feel much more comfortable knowing that it was two floors down.

“I would say, has he asked the patient or parents?” Craig responds. “Surgeons are timetabled to work at both hospitals, they have to be flexible but that is what doctors do.

“Gastroenterologists are here when we need them, surgeons are here when we need them. They can be here every half an hour, they can be here every day of the week. So it does become a bit emotional yes, because it’s like, ‘why don’t you get this?’ This feels like such a matter of an interpretation of standard, the paranoid among us think there’s something else going on.

“The number of people you need for a 1,000 bed hospital means it can be impersonal. You pick up the phone to talk to the labs here and you know who they are. Would it be better to build a brand new hospital with everything under one roof? Where’s the money to do that? And what’s the benefit? It’s the theoretical risk, which hasn’t happened, that the surgeon might not be there when we want him. What actually happens is one of his colleagues covers. Even in bigger hospitals, there’s no guarantee the paediatric surgeon is immediately available either. We have done this for decades with outcomes which are the envy of the world.”

That’s all from today’s liveblog. A huge thank you goes out to the staff and patients at Royal Brompton hospital, and to you of course for reading.

Stroke survivors ‘are dumped by the NHS’. Dead patients don’t vote, and those near death don’t appear to count…

If you have a stroke on your way to the hereafter, your life expectancy is short, demand for services is high, and nobody listens to you, even if you can be understood.  Dumped is the right political word. Congratulations to the reporter on his understatement however, The real word, especially with regard to intensive physiotherapy, is abandoned. Dead patients don’t vote, and those near death don’t appear to count. Commissioners have a perverse incentive to save money, richer areas can have more physio as more patients go privately, and the post-coded, covert rationing lottery continues..

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Jon Ungoed-Thomas in the Sunday Times reports: Stroke survivors ‘are dumped by the NHS’

Sufferers feel abandoned after leaving hospital and face waiting up to a year for the right treatment — or paying for it themselves

Stroke survivors are being left to languish at home with a “shocking” lack of support. Many say they feel abandoned by the NHS.
Juliet Bouverie, chief executive of the Stroke Association, said a new national plan was required to help the 1.2m stroke survivors in the UK. Some have to wait up to 12 months for psychological help.
“As a stroke survivor, your life and the life of your family is turned upside down,” she said. “Many stroke survivors say they feel abandoned, as if they have dropped off a cliff. The provision in some areas is shocking.”
About 100,000 people suffer a stroke every year in the UK; it is one of the country’s leading causes of death.
Andrew Marr, the broadcaster and journalist, who suffered a stroke in January 2013, said better support for stroke survivors — many of whom are of working age — could help them return more quickly to employment. He was back at work within six months, but largely because he paid for additional physiotherapy.

Stroke survivors can wait up to four months for speech therapy and up to a year for psychological support, according to data from the Royal College of Physicians. Stroke survivors say there is insufficient physiotherapy, a treatment which would ensure the best recovery.

Andrew Marr, who had a stroke in 2013, paid for physiotherapy to help him get back to work sooner<img class=”Media-img” src=”//″ alt=”Andrew Marr, who had a stroke in 2013, paid for physiotherapy to help him get back to work sooner”>
Andrew Marr, who had a stroke in 2013, paid for physiotherapy to help him get back to work soonerDavid Cheskin/PA

A stroke strategy, launched in 2007, outlined a 10-year plan to overhaul stroke services and has seen significant improvement in acute treatment. The Stroke Association is calling for a new action plan to build on improvements and outline a new strategy for the rehabilitation of stroke victims.

Nathan Ridgard, 40, a self-employed businessman and a father-of-two from Harrogate, North Yorkshire, suffered a stroke on New Year’s Eve 2012. After being discharged from hospital, he said he was given some leaflets by the NHS on coping with a stroke, but struggled to read them because of his poor vision.

“I just felt I had been dumped out in the world,” he said. He received some NHS physiotherapy, but also paid for private sessions to supplement them. He has since made a good recovery.

Professor Tony Rudd, National Clinical Director for stroke at NHS England, said: “The quality of care and survival rates for stroke are now at record highs. We are working with the Royal College of Physicians and others local health service leaders to improve rehabilitation care for everyone who suffers a stroke.”

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