Agenda item

To consider the report of the Director of Transformation and Governance on proposals from the NHS or providers of health services to vary or develop health services in the area of the Committee.

Items for Action

• NHS Guildford and Waverley and NHS North West Surrey CCGs: West Surrey Stroke Services

Representatives of NHS Guildford and Waverley CCG, together with colleagues from Hampshire CCG Partnership, provided an overview of the report and presentation on the future of West Surrey Stroke services (see report, Item 10 in the Minute Book).

Members heard that a consultation had been carried out earlier in the year, with some initial findings available, which raised some concerns relating to ambulance times, early supported discharge, and stroke rehabilitation in Hampshire.  A summary of stroke services, the proposals, and how these were reached were summarised from the papers, as well as the impact that this would have on a small population principally in South East Hampshire who would usually be conveyed to Royal Surrey County Hospital to receive stroke care.

It was heard that nationally there was a 40% vacancy rate for stroke consultants, which made it difficult for major hospitals to provide seven days a week hyperacute stroke medicine and care.  Staff rota sustainability had been one of the drivers for the current stroke pathways in West Surrey being reviewed, presenting an opportunity to design proposals which would see the service specification for stroke care in Surrey being met.

It was explained that it would have been preferable for the ‘status quo’ of current stroke services to have remained over the period of the consultation and proposals being considered, but with one of the two consultants providing stroke care in Royal Surrey County Hospital resigning to take up a new position in London, it was mutually agreed by the provider and commissioners that the stroke unit would temporarily close due to unsustainable staffing levels, with those suspected to be suffering a stroke instead being conveyed to Frimley Park Hospital or St Peter’s Hospital depending upon where in Guildford, Waverley or South East Hampshire the stroke occurred..

Commissioners had been working to engage the public and service users, and had held a number of sessions with focus groups.  In addition, commissioners had collaborated with the stroke association and HealthWatch on the proposals.  The NHS Transformation Unit (a not-for-profit NHS organisation independent of all parties affected by the plans under consultation)  were working to analyse the outcomes of the consultation, which would be considered at the ‘Committees in Common’ meeting on 4 July.  This meeting would also take decisions on the future model of care, taking on board feedback from the consultation.

The issues with South East Coast Ambulance (SECAMB) NHS Foundation Trust were well known to commissioners and had been raised through the consultation.  An improvement plan was in place to assist the Trust to meet performance targets.  Both Ambulance providers, SECAMB and South Central Ambulance (SCAS) NHS Foundation Trust, had been involved in the development of the proposals, and would be working with commissioners to finalise pathways and handover arrangements should the proposals be agreed.  SCAS had advised commissioners that once the proposals were more firmly developed, it could convey patients in line with proposals in a safe and timely manner.

In response to questions, Members heard:

·         In terms of the impact of the proposals on the Hampshire population, of the 344 recorded strokes in the South Eastern Hampshire area in 2015/16, approximately 30 to 40 of these patients would have previously been conveyed to Royal Surrey County Hospital.  Of those living in the North Hampshire and North East Hampshire and Farnham areas, approximately one person per area would be impacted.

·         That all providers of stroke care in West Surrey are supportive of the proposals, and the proposals have clinical leadership support.

·         That ambulance travel time analysis, reported by SCAS, had shown that it would take approximately an additional four minutes from the area of Whitehill and Bordon to reach Frimley Park Hospital, as opposed to the previous journey to Royal Surrey County Hospital.  Currently, the average time for call to treatment was one hour 20 minutes, so an additional four minute conveyance would still be within the two hour target time, and outcomes would be better should services be centralised at Frimley due to the availability of seven-day care.

·         A full 12 week consultation had been held and this had included the areas of Hampshire affected.  A public event was held in Liphook, and details of the consultation and events were sent to all GP surgeries and Parish Councils affected, but feedback that an event should have been held in Whitehill and Bordon would be taken on board for future engagement.  All Members of the HASC in the previous administration were notified of the consultation and were welcome to engage directly with the CCG.

·         Further work would be undertaken with the two Ambulance Trusts to continue to improve response times, although it was expected that improved handover once a patient has been conveyed to the hyperacute stroke unit would see ambulance times reduce, and there would be direct handover to stroke teams.  In addition, it was emphasised that SCAS had some of the best conveyance times in the country.

·         That improved outcomes for stroke patients are at the core of the proposals, with clinical evidence supporting the notion that centralising stroke care, and increasing the number of cases clinicians treat per year, leads to decreased rates of disability and mortality.

·         Prevention of stroke was also an important stream of the stroke review in West Surrey, and work was ongoing through the Hampshire and Isle of Wight STP to better target prevention at those at risk of having a stroke through primary care services.

In discussion, it was agreed by the Committee that although the proposals constituted a likely substantial change in service for the 32 to 42 patients per year who would have previously been conveyed to Royal Surrey County Hospital, the four tests of service change had been met and the proposals would result in an improved model of care for those suspected of having a stroke in North East Hampshire.  Therefore the Committee were content to support the proposals at this stage in the process, with the exception of Councillor Adam Carew, who abstained from voting on the recommendations.

RESOLVED

That Members:

a.     Support the proposals for stroke services in West Surrey.

b.     Request an update on this service in September 2017.  That this update includes information on the work undertaken to date with Hampshire’s two Ambulance providers to ensure that the proposals can be fully supported, as well as the full outcomes of the public consultation and the actions the CCG will take to meet feedback from this exercise.

Councillor Mike Thornton left the meeting.