Agenda item

Purpose of the report:  Scrutiny of Services

The Surrey Clinical Commissioning Group (CCG) Collaborative previously informed the Wellbeing and Health Scrutiny Board about work being undertaken to commission improved stroke services, following the Surrey Stroke Review. This update outlines progress working with health systems across Surrey and proposed engagement approaches. Advice is required about the timeline for formal public consultation.

Witnesses:
Claire Fuller, Chair of the Surrey Stroke Review

Giselle Rothwell, Acting Associate Director of Contracts

Strategic Commissioning, NHS North West Surrey Clinical Commissioning Group
Matthew Parris, Evidence and Insight Manager, Healthwatch Surrey
Nick Markwick, Surrey Coalition of Disabled People

Declarations of Interest:

None

Key points raised in the discussion:

1.    The Chair of the Surrey Stroke Review noted that 2,500 residents within Surrey had a stroke annually, and that there was a higher mortality rate compared to the London region.

2.    The Board was told that feedback from service users had highlighted that stroke treatment within the hospital service was considered to be good. Feedback had also shown that after-care was considered to be in need of improvement. The Board was informed that the Stroke Review was seeking to improve the whole pathway for stroke sufferers, including after-care. This pathway was now being considered as the standard for a national model.

3.    The Board was informed that proposals had been drawn up to provide three Hyper Acute Stroke Units (HASUs) to be delivered across an East system, a West system and a Surrey and Hampshire border system. These models were undergoing an assurance and feedback process with the next steps being decided by the Clinical Commissioning Group (CCG) Committees in Common in October 2016.The Board was told that if a significant change was required, an extended consultation period would be considered to take into account the winter holidays.

4.    Witnesses highlighted that St. Peter’s Hospital, Frimley Park Hospital and East Surrey Hospital were being considered for the HASUs. The Board queried whether there would be follow-on care available in Royal Surrey County Hospital, for ease of access for people in high population areas such as Guildford. It was confirmed that there would be an improved focus on after-care services and also encouraging prevention, and that this would reduce the need for acute hospital services.

5.    The Board queried whether the financial sustainability of the NHS would see plans needing to change after public consultation. It was explained that working models were changing to ensure continued delivery of service within the financial envelope provided. Witnesses noted that this was a challenge, but that improved ways of working were being developed as a result of this.

6.    It was noted by witnesses that there was a robust engagement process in place with patients and stakeholders. The Board questioned the level of consultation and whether deprived groups were reached out to in the consultation process. The service responded that a wide range of groups had been consulted, noting the Stroke Association as an example, as well as service users, to gain a wide insight.

7.    The Board queried whether there was any synergy between the Surrey Clinical Commissioning Groups (CCGs) regarding funding priorities. The Chair of the Surrey Stroke Review informed the Board that there was good engagement between the CCGs, highlighting that the Committees in Common works to agree joint funding priorities.

8.    The representative of Healthwatch Surreyqueried whether there were groups within Surrey that were at risk as a result of the new proposals outlined. A Board Member commented that the high number of patients in a small number of hubs could cause some difficulties which would have to be managed. Witnesses outlined that stroke patients should receive treatment within one hour to produce the best chances for recovery, and that journey times across Surrey had been measured as part of consideration for the sites of the proposed HASUs.

Recommendations:

The Board welcomes the increased emphasis on follow up in stroke services through the review, and recommends:

1.    That an update provided to the Board following the final decision by the committee in common on 6 October 2016;

2.    That this update demonstrates how consultation activity will engage with identified high risk groups, and those families and patients involved with ongoing care following a stroke.