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In September 2017 a review of stroke services in Surrey recommended that the Royal Surrey lose its Hyperacute Stroke Unit (HASU) – a decision I opposed.  As reported in previous blogs, I on behalf of Royal Surrey Governors sought to persuade authorities to at least preserve Royal Surrey’s Acute Stroke Unit. That would allow those people living in Guildford and Waverley who experience a stroke and are taken to HASUs either at Frimley or St Peters, to continue acute care in the Royal Surrey close to family, friends and carers. The Royal Surrey Executive was in favour and as a result Frimley and the Royal Surrey came to an arrangement to allow this to happen and consequently Royal Surrey now has an ASU with a stroke consultant who shares her time with Frimley.

However no similar agreement proved possible with St Peters and, as reported in other blogs. I continue to pursue the matter particularly since it is people from Guildford who are most likely to be taken to St Peters and I am an elected Governor for Guildford.

In August last year I met with Claire Fuller who heads up the Surrey Heartlands Healthcare Partnership. She was sympathetic to the problem and told me several activities were underway which might have an impact and we agreed to meet again when matters were clearer. Thus on 2 January I met again with Claire Fuller who was joined by Mathew Tait who is the Chair of the Stroke Oversight Group for the Surrey Clinical Commissioning Groups (CCGs).

They were both very sympathetic to governors’ concerns but pointed out that

1.    An NHS England review was underway of stroke services in Surrey, Kent and Sussex. That will report later this year and might impact on HASU/ASU provision in Surrey but whatever the result any impact would be a long way off. Whether it would affect St Peters’ HASU and thus relationship with Royal Surrey is unknown.

2.    The number of stroke patients arriving at St Peters is significantly below the predictions of the modelling undertaken in the original CCGs review. Discussions with SECAMB had increased numbers slightly but this shortfall is of obvious concern. An audit is underway of stroke patients who have been taken to St Peters to get a clearer view of their pathways. This will report soon.

In the Guildford and Waverly CCG risk management report of 24 July 2018 the following was in the top 10 risks

“(Surrey Heartlands CCGs) if the flows from Guildford to ASPH for stroke patients are not achieved as modelled there is a risk that the clinical benefits and critical mass will not be realised and patient outcomes will not improve; workforce challenges and recruitment deteriorates; financial sustainability of the HASU/ASU at ASPH”

This has consequences for the likelihood of an agreement for patients from Guildford to be able to go to the Royal Surrey ASU after care in St Peters’ HASU.  Such an agreement would damage the fragile financial viability of St Peters stoke services – a consequence which would be unacceptable in that it would put at risk all the patients who they treat from other areas.

An audit of St Peters stroke patient pathways is underway. Mathew Tait said he would request that figures for patients originating in the Guildford area be analysed. It could be that ambulances are in fact taking ”Guildford” patients to Frimley hence the numbers problem at St Peters. If so the number of “Guildford” patients could be small thus diminishing the problem and, ifnumbers are small, perhaps they could transfer without much financial consequence.

Secondly stroke patients are likely to be away from home for the longest period when in a community rehabilitation facility and perhaps it is here that patients will most want visitors. Maybe it is at this stage that “Guildford” patients could transfer to a community rehabilitation closer to home rather than to Woking which is the default at the moment. Claire and Mathew said they would look in to this together with the results of the audit.

It was agreed that another meeting would take place as soon as the audit analysis had been completed – probably in 3 or 4 months. I will report.