Minutes:
Mr. James Blythe, Director of Commissioning, Surrey Downs Clinical Commissioning Group spoke to the Panel regarding the current review of Surrey Stroke Services, supported by presentational slides.
The Panel was informed that the review had been running for 18 months now and did not only involve commissioners of NHS services and national experts in stroke care but everyone involved in the provision of care for stroke patients, including patients themselves, their families and carers. It was clear that care for stroke patients crossed social and health care boundaries and had a significant impact on both patients and services.
Acute services were currently located at St. Peter’s Hospital, Frimley Park Hospital, Royal Surrey County Hospital, East Surrey Hospital and Epsom Hospital. Community care was provided at six locations throughout the County, one of these being the New Epsom and Ewell Cottage Hospital.
Strokes affected a significant number of people in Surrey each year but outcomes could be better. The stroke mortality rate for Surrey Trusts was 16.5% in 2014/15 compared to 12% in London or the national average (14.2%). Whilst the CCG worked very closely with hospitals and partners and the situation had improved since 2010/11, in other parts of the UK, changes in stroke services had helped people live longer and reduced disability. In particular, London Trusts had reviewed the organisation of services and consolidated hyper acute services into a small number of units for the first 72 hours after a stroke prior to moving a patient to an acute unit.
The Panel was informed about what people had told the CCG currently worked well and what could be made even better in terms of service provision. In particular, it was noted that patients had identified the availability of services at the weekend and at night as an area for improvement. Currently only Frimley Park offered a full range of services at these times which was indicative of the fact that specialist care was very spread out at the moment.
The Panel was further informed of the headline results from the public survey which, amongst other matters, indicated that the majority of respondents (78%) would be prepared to travel for up to 30 – 45 minutes if that meant being in a hospital with the most experienced doctors and nurses. This might be considered a surprising result but reflected the strength of evidence regarding the benefit of specialist care.
Based on the latest clinical evidence and the number of strokes in Surrey, the review had concluded that, across the county, there was a need for three Hyper Acute Stroke Units (HASUs) to provide specialist care for stroke patients. An expert panel had concluded that based on travel times and geography, the best locations for these units would be in Frimley, Chertsey or Guildford and Redhill.
The East Surrey Hospital was being suggested because of its relative accessibility and the fact that it took admissions from the neighbouring County of Sussex. For it not to provide such services could have an impact on Sussex residents but it was recognised that not locating such services there would free up capacity at the hospital in other areas to the general benefit of all patients. It was too early to say that no stroke services would be provided at Epsom Hospital. Whilst evidence suggested that the HASU might be sited at East Surrey Hospital, it could well be the optimum model to site an acute unit at Epsom.
The CCG was currently working on a service specification setting out the improved performance it would wish to see (i.e. reduced mortality and improved Sentinel Stroke National Audit Programme ratings to – the ‘A’ standard within two years) and was asking acute trusts and community providers in Surrey to work together to look at how care could be provided with a three HASU model. Providers were being asked to come back with this model by March 2016 prior to public consultation.
The Panel was assured that the review was not driven by financial considerations/pressures but a desire to achieve better outcomes by investing in and consolidating the workforce to strengthen expertise and provide 24/7 care.