Agenda item

Purpose of the report: Scrutiny of Services

A countywide review of the stroke pathway is underway and the leaders of the review will present the work undertaken thus far and the next steps for the review

Report to follow

Declarations of interest:

None

Witnesses:

Dr Claire Fuller, Acting Clinical Chief Officer, Surrey Downs CCG

SuziShettle, Head of Communications and Engagement, Surrey Downs CCG

Key points raised during the discussion:

1.    A public question was received by Bess Harding (see item 4) about funding for consultants at Epsom General Hospital complementing the work done by the community to raise funds for equipment. The Acting Clinical Chief Officer answered the question by stating that the management for the stroke unit has improved and that they are recruiting a specialist stroke doctor to deal with the shortage issue. It was explained that this review aims to improve outcomes for Epsom and Surrey patients as a whole; it is not about individual services.

2.    Witnesses felt that there was misinformation about treating stroke; in that it is not simply about the number of consultants there are, there is challenge because of a regional shortage of Speech and Language Therapists. Work to re-shape geriatrician roles may help but Health Education England have a role to play to improve quality, improve attractiveness and retain staff in this area.

3.    The Clinical Chair also explained that strokes are more common among people with an irregular heart beat and that identifying this condition (known as Atrial Fibrillation) is important to help prevent strokes. It was stated that 70% of Atrial Fibrillation (AF) strokes are preventable, if all cases of AF were idenitifed and all patients correctly treated with anticoagulation. National campaigns such as ‘FAST’ have helped to raise awareness about the signs of stroke and what to do if someone witnesses someone having a stroke. The Board queried whether there should be a Surrey wide campaign for stroke recognition and the precursor to a stroke: Transient Ischaemic Attacks (TIA).

4.    There was an overall agreement with the Board that stroke services were not acceptable, as it was stated that if you had a stroke in Surrey you are more likely to die than if you had a stroke and were living in London. It was decided by the Board that a more creative solution needs to be thought of to increase standards within Surrey hospitals by allowing everybody to access the right care.

5.    The Board was advised that the Commissioners do not want to replicate London’s models but they do want to achieve their outcomes. This would require hyper specialist acute units in Surrey with the whole pathway under consideration – community provision; discharge capacity needs to improve especially in the east of the county around SASH.

6.    The Board was concerned by the lack of access to Stoke Units in Surrey and what the workforce challenges were. They inquired when they will start to see progress and were informed that there will be a sustainable solution for Surrey, including Epsom, with six potential new consultants and recruitment opportunities for speech and language therapists. 

7.    A question was asked regarding the data presented to the Board including differences between Epsom & St Helier hospitals and other Hospitals in Surrey, declining outcomes at Frimley Health as the Trust now includes the previously challenged hospitals of Heatherwood and Wexham Park. Additionally, Members felt that comparison of Epsom and SASH required further investigation. They also asked whether mortality rates cross-referenced with those held by the Coroner. The Acting Clinical Chief Officer agreed to provide further information on these points outside the meeting.

8.    The Commissioners were working hard to pin down the outcomes they want to get from the system of providers. Three units across five acutes were proposed. This model was checked by the Clinical Senate and in the East Surrey and Epsom cases – data showed that a system response was required to improve outcomes. Furthermore, Capgemini modelled all the options and found that even two out of five would be enough for Surrey but three units offers capacity.

Recommendations:

The Board thanks the witnesses and requests a further update on the delivery of the proposed service specification at its May 2016 meeting.