You know about HASUs so what about ASUs?

In previous blogs I have reported that that 3 Clinical Commissioning Groups have collectively decided that the number of Hyper Acute Stroke Units (HASUs) in Surrey should be reduced from 5 to 3 and be located in Frimley, St Peters and East Surrey hospitals. The Royal Surrey will lose its HASU and those who have stokes in Guildford will be taken to St Peters and those south of Guildford to Frimley. There will be consultation in Jan/Feb next year but I cannot see this decision being changed.

However the question arises as where patients will go when their spell in the HASU has ended. The argument may be that those from Guildford in St Peters HASU should transfer to an Acute Stroke Unit (ASU) in St Peters itself assuming acute care is still required. However many patients having completed a HASU spell, might wish to be transferred to the Royal Surrey for further acute care prior to going home or to a rehabilitation unit in a non-acute setting. This would allow patients to be close to family and friends during what is often a difficult time.

The downside would be moving away from the clinicians who have treated you at the most dangerous time. However that is soluble given some joint working between St Peters and the Royal Surrey. The same issues arise of course between Frimley and the Royal Surrey.

Here then is an area where consultation could actually be meaningful provided of course the authorities are prepared to listen !!

Another hospital rating system

We have become familiar with Care Quality Commissioner’s inspections and ratings. In the last round Royal Surrey was ‘Good’, Frimley ‘Excellent’ and St Peters ‘Requiring improvement’.

Now the NHSI (NHSImprovement) has introduced ‘The Single Oversight Framework’ designed to help NHS providers attain, and maintain, Care Quality Commission ratings of ‘Good’ or ‘Outstanding’.

The Framework aims to help NHSI identify NHS providers' potential support needs across five themes:

·         quality of care

·         finance and use of resources

·         operational performance

·         strategic change

·         leadership and improvement capability

The Royal Surrey has received a rating of ‘3’, Ashford and St Peters ‘2’ and Frimley ‘1’.

The meaning of the ratings are roughly:

1.    No potential support needs identified.

2.    Targeted support needed: there are concerns in one or more themes.

3.    Mandated support needed for significant concerns: there is actual or suspected breach of licence, and a Regional Support Group has agreed to seek formal undertakings from the provider or the Provider Regulation Committee has agreed to impose regulatory requirements.

4.    Providers in special measures.

Whilst not good, this is not surprising given the Royal Surrey’s very poor financial position and that it is seriously missing some key targets such as cancer waits. Whereas every effort is being focussed on improving it is going to take time to get back to past performance. At least the hospital has decided not to merge with Ashford and St Peters allowing senior staff to concentrate on getting the hospital back onto an even keel.

Stroke review.   As I noted in an earlier blog a formal consultation is promised on proposed alteration to stroke services in Surrey as a result of a review by Clinical Commissioning Groups. Despite promises of consultation, plans are being put in place for implementation. So I do not expect any consultation will make a difference. In essence there will be just three Hyper Acute Stroke Units in Surrey and they will be in Frimley Park, St Peters and East Surrey hospitals. The Royal Surrey will lose its stoke unit and patients with a stroke in the Guildford area will go to St Peters in Chertsey. Those having a stoke to the South of Guildford in the area bounded by Cranleigh, Haslemere and Elstead will go to Frimley Park. Already staff in the Royal Surrey are being spoken to re their future and St Peters is looking to off load some of its patients to the Royal Surrey to create bed space for more stroke patients.

Turning the Royal Surrey around.  The Royal Surrey continues to strive extremely hard to turn itself around financially. Many savings are being made with most coming from a reduction in staff numbers and in expenditure on Agency, Bank and Locum staff. Nevertheless the deficit at the end of the financial year is unlikely to be substantially different from last year save for the expectation of a substantial financial injection subject to conditions laid down by NHS Improvement which continues closely to monitor the hospital’s progress. Times are really tough and that goes for all hospitals.

On the non-financial side NHS Improvement expects improved performance on A&E waits and cancer waits. My main concerns have focussed on cancer waits particularly the 62 day wait target from GP referral to treatment. The hospital performs very poorly in the area of urology a fact which I point out at every opportunity to push for more determination and detailed plans to sort matters out. I hope this is coming about. Some patients referred from other hospitals arrive at the Royal Surrey after much of the 62 day wait has been expended and sometimes after 62 days have already elapsed. This is a disgrace and requires strong representation to these offending hospitals at a CEO to CEO and Chairman to Chairman level which I will monitor to see that it happens. The relevant Commissioning Groups have a responsibility here also

The Sustainability and Transformation Plan for Surrey Heartlands. Very hectic activity is underway to review all the acute and community health services and social services in Surrey Heartlands (an area bounded roughly by Woking and Ashford to the North, Haslemere to the South. Guildford to the West and Epsom to the East). Very substantial changes to services and health institutions in this area can be expected. A public engagement plan is being put in place for later this year/beginning of next. I am one of the governors on the ‘Stakeholder Engagement Group’ and will report from time to time. I am watching A&E services, maternity services and cancer services in particular to see how they might impact on the Royal Surrey. An earlier blog reports that the Royal Surrey is to lose its stroke services and I fear lest it also loses its A&E and Maternity services to become not a General Hospital as now but just a Cancer Centre. That is not a current proposal but I fear the direction of travel. More to come in due course.

The Royal Surrey to lose stroke services

For some time the Surrey Clinical Commissioning Groups (CCGs) have been reviewing the provision of stroke services and, for W Surrey, have concluded there should only be two 'Hyper Acute Stroke Units (HASUs). They propose they be at Frimley Park Hospital and at St Peters Hospital. The Royal Surrey in consort with St Peters has indicated its agreement. 

The purpose of limiting the number of HASUs is to make sure each has a sufficient number of patients to build experience and  expertise and to ensure they are big enough to justify top level equipment and supporting services. St Peters is expert in cardiology and vascular surgery which tips everything in its favour. It has been shown that patients have a much better chance of survival and of avoiding post -stroke complications in large and well equipped HASUs. The centralisation proposed is therefore aimed at better clinical outcomes.

On the other hand speed is of the essence in strokes. It is essential to get patients to a HASU as soon as possible and certainly within a clinically reasonable time. The CCGs has studied ambulance travel times from all the points in West Surrey and is claiming that clinically reasonable ambulance travel times can be achieved with HASUs in only Frimley Park and St Peters. Ambulances with stoke patients would no longer go to the Royal Surrey and it will lose its existing stroke facilities which have always been highly rated in external audits.

Clearly for residents of Guildford and environs (and other places) ambulance travel times will be very substantially increased and will be a  matter of obvious concern.

The CCGs have an obligation to consult the public and this it will do  from July to September. Nevertheless the chance of anyone changing their mind is, in my view, minuscule (an advert for a Clinical Director for St Peters is already underway).

New Chief Executive

The Royal Surrey County Hospital has appointment Paula Head as its new Chief Executive. She will start in the Autumn.

Paula has Board experience in both the acute trust and community setting. She trained as a pharmacist and rapidly progressed to management roles within this field. She then joined the NHS where she held a number of strategic and operational roles, including having responsibility for a number of the operational and clinical departments in an acute trust.

Currently she is Chief Executive at Sussex Community NHS Foundation Trust and has seen the Trust through its successful application to achieve Foundation Trust status. Prior to that she spent three years at Frimley Park Hospital as the Director of Transformation.

She faces an enormous challenge in tackling the hospital’s serious financial difficulties. One of her first tasks will be to appoint a new Finance Director.