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The links between hospitals and social care have got worse not better, poor health services are still being protected and preserved, and quality improvement has been cut. These are among the hard-hitting messages from the outgoing national clinical director for stroke services, Tony Rudd.

In this HSJ Health Check special, Professor Rudd \u2013 who previously oversaw the move to hyper-acute stroke services in London, where he was a long-serving consultant \u2013 shares six hard-hitting reflections and suggestions from his time at the centre of service reform.

His observations include:

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• There\u2019s no evidence of improvement in the link between hospitals and care services;
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• The NHS has failed to shift spending \u2013 and research \u2013 away from acute care;
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• Community hospitals should be closed to invest elsewhere;
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• Businesses would fail if they copied the NHS's cuts to quality improvement and clinical data; and
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• The NHS has too much local decision making.
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