Royal Surrey Community contract

The Royal Surrey together with Procare Health Ltd have bid for the contract to run adult Community Services across Guildford and Waverley including Haslemere, Milford and Cranleigh Community Hospitals. They are the preferred bidder at this time and therefore, subject to detailed agreements, can expect to be successful to start at beginning 2018/19. These services were run by Virgin Healthcare.

Procare Health Ltd is a private company run by GPs.

Bringing together provision of acute and community services offers many exciting opportunities provided of course that the services are well run in accord with community wishes and involvement. Haslemere, Farnham and Milford Hospitals have a special place in the hearts of the communities they serve and it will be important to ensure those communities are happy with the change in management and the opportunities that presents.

More information when I get it.

Awards

Five teams in the Royal Surrey were shortlisted recently for the Nursing Times award. Although they didn't win the fact that five were shortlisted is a great credit to the hospital.

Strokes. 

I may have been quiet recently about Stroke Services but I have been actively pursing the matter of ensuring that Guildford stroke victims who are taken to St Peters Hyper Acute Stroke Unit have the option of being cared for in the Royal Surrey once they have been stabilised. This would put them on the same basis as those patients in the Royal Surrey Catchment area e.g. Cranleigh who are taken to Frimley Hospital. It is difficult persuading those in authority whose minds seem to be closed but I continue to try and will be meeting Paula Head the Royal Surrey Chief Executive in the New Ya-ear to sort out how I might proceed further.

Stroke services decision

Today (7 September) the Guildford and Waverly and N W surrey CCGs (Clinical Commissioning Groups) met to decide on Stroke Services following their consultation.  As proposed, the two HASUs (Hyper-Acute Stroke Units) in West Surrey will be at Frimley Park Hospital and St Peters Hospital in Chertsey. This is despite over 60% of respondents opposing the proposals essentially because those consulted wanted the two to be Frimley and the Royal Surrey.

However there was a very significant change re ASUs (Acute Stroke Units to which patients go once they are stabilised in a HASU). I and fellow Governors (see earlier blogs) pressed for the Royal Surrey to have an ASU and for involvement in rehabilitation rather than everything happening in St Peters and Frimley Park. This was clearly the wish at the meeting which the Royal Surrey organised for Trust members. The Royal Surrey after the members’ meeting submitted a proposal on those lines.

I am pleased to say that the CCGs have decided that there should be a “networked HASU and ASU” arrangement between Frimley and the Royal Surrey with the ASU being located in the Royal Surrey. They have also decided that there be bedded specialist rehabilitation in the Royal Surrey linked to the ASU and with access to non-specialist rehabilitation.

This good news BUT a similar arrangement with ST Peters has not been agreed. That is not good news for the people of Guildford the majority of whom will be taken to the St Peters’ HASU. I raised this at the joint meeting of the two CCGs and they agreed to look at this again, However such undertakings have a habit of dying and so I will be doing my best to ensure this does not happen.

Blue Badge holders will be charged £4 per visit for parking the Royal Surrey has decided.

The hospital is still struggling financially and the justification is that it needs to find ways to increase income and cut costs. As part of its justification is that other hospitals charge the disabled. I was not in favour of this change and said so and see no reason why the Royal Surrey should charge because others do – I would rather be on the side of the angels !! That having been said I do recognise that many holders of Blue Badges are not financially challenged and could afford the £4 just as much as many non--disabled patients some of whom are very hard pressed. I have therefore pressed the hospital to operate an effective scheme for waving the charge for those on benefits or otherwise in financial difficulties. This they will do.

Of course it will be necessary to have modified parking meters so that wheelchair users can reach buttons. These will be installed. I hope the hospital will consult with disabled patients and their representatives to ensure there are sufficient such machines and that the processes for waving charges operates efficiently, sensitively and smoothly. I will check in a few months.

A detailed analysis of the results of consultation on stroke services in West Surrey has been published albeit a decision has yet to be made known.402 questionnaires were returned, 178 people attended 13 events and there were 93 individual responses one of which was mine (see earlier blog). Geographically the responses from Woking, Weybridge and Chertsey, Staines and East Hampshire were small. Guildford and Waverly dominated.

Considering the following 3 statements:

• Access to seven day specialist stroke services should be provided at Frimley Park Hospital and St Peter’s Hospital to enable more people to survive a stroke and minimise risk of disability 
• Seven day clinics for transient ischaemic attacks (TIA) should be provided at Frimley Park Hospital and St Peter’s Hospital as part of the specialist stroke service
• The reason for concentrating in-hospital stroke specialist rehabilitation services in fewer hospitals in West Surrey is justified and supported

Overall the results were:

• ·         First statement 77% disagreed/strongly disagreed, 21% agreed/strongly agreed
• ·         Second statement 74% disagreed/strongly disagreed, 21% agreed/strongly agreed
• ·         Third statement 83% disagreed/strongly disagreed, 15% agreed/strongly agreed

 Geographically:

• In Guildford, Waverley and East Hampshire the majority of respondents disagreed with the statements but a significant proportion of respondents supported them.
• In Woking, the majority of respondents agreed with statements but a significant proportion disagreed.
• Responses from Weybridge & Chertsey and Staines were very low but agreement was almost 100%

 Most common themes were:

• Concerns about removal of services from Royal Surrey, preference to position some stroke services there and concerns about the hospital’s future
• Importance of timely treatment
• Recognition that specialist workforce and equipment has benefits, with differences of opinion on location
• Importance of equitable access but concerns that plans create inequity
• References to travel distance and time with implications for timely treatment, visitor access, patient wellbeing and public transport
• Ambulance availability and concerns about SECAMB.

 All very predictable. 

National Elderly-Friendly Quality Marks have just been awarded to Hindhead and Ewhurst wards in the Royal Surrey. This means that the Royal Surrey is home to three of the 26 wards which have been awarded nationally. The awards are are given by the Royal College of Psychiatrists. The award is based on assessors collecting information from patients, carers, visitors, ward staff and hospital managers and thus not lightly given. Myself and two fellow governors were involved in checking the wards for cleanliness, maintenance, general environment, presence of dementia friendly features and food quality. I can therefore testify directly to the justification for this national recognition - well deserved.

Here is my contribution to the Stroke consultation.

Dear Sir/Madam

Public Consultation on ‘Improving Stroke Care in West Surrey’

Siting of HASUs

I would ask the CCG to step back from its proposal for the siting of HASUs in West Surrey and objectively ask whether it has got the balance of risks to patients correct. I recognise that to change this aspect will be extremely difficult for those who have worked on this matter for so long but nevertheless, for the sake of patients, I would ask them to have the courage to change if, on reflection, it is not in the best interests of the public who are at risk.

I support the reasoning to concentrate services in just two well-staffed and supported HASUs in West Surrey. However siting them in Frimley Park and St Peters is not the right solution geographically. Speed in getting stroke victims to a HASU is paramount. The consultation repeatedly presents a travel time of 2 hours from onset to treatment in a HASU as if anything less is not of significance. This is not so. 2 hours is regarded as a maximum: less is highly preferable.

The proposed configuration is for two hospitals which are both in the north of West Surrey (and only about 20 minutes apart by road), and closing the one hospital i.e. Royal Surrey which is in the middle of West Surrey. This is unbalanced. It puts at significant risk stroke victims in Guildford and particularly those south of Guildford e.g. Cranleigh and Haslemere. The contention that the ambulance service can still get patients to these hospitals to meet the 2 hour maximum from stroke onset is not tenable given the unsatisfactory performance of that service (which has been clear to the public for a long time and continues despite many undertakings to improve). In any case 2 hours is a maximum not an optimum. Very clearly these patients could get to the Royal Surrey far faster and in that respect alone are being put at significant increased risk.

The choice between the Royal Surrey and St Peters, it is said, was left to the two hospitals to decide between themselves. That decision should be reviewed independent of any of those who have so far been involved.

It the two HASUs were located at the Royal Surrey and Frimley hospitals stroke victims who would otherwise go to St Peters would split between Royal Surrey and Frimley. The admissions to Royal Surrey would rise to over 700 (CAP Geminini Report on stroke modelling commissioned by the CCG) well above the 500 regarded as the minimum optimum size stated in the consultation booklet. With Frimley being close to St Peters to the North and Royal Surrey being close to patients to the south of St Peters this would be a preferable risk balance given the excessive travel times to Frimley and St Peters from places such as Cranleigh and Haslemere.

I recognise that St Peters has the advantage of undertaking vascular surgery which some stroke victims will require. However such surgery is not time-sensitive in the same way as initial stroke treatment. Such patients can be safely transferred to St Peters. Although this is not desirable for the few patients concerned, it is not unsafe.

It is fundamental to any proposal for change that the current performance of hospitals be taken in to account.  The latest case mix Standardised Mortality Ratios for stroke published by SSNAP (the CCG’s preferred source of data) shows

• ·         Royal Surrey’s SMR as 1.0 i.e. mortality as “expected” for its case mix
• ·         Frimley’s SMR as 1.08 i.e. 8% higher than expected
• ·         St Peters as 1.15 i.e. !5% higher than expected – very worrying

St Peter’s mortality should be subject of serious investigation quite apart from the matter of this consultation. That patients currently taken to the Royal Surrey from Guildford should now be being taken to a hospital with such a substantial mortality rate is extremely disturbing.

Siting of ASUs

Even if HASUs are sited as proposed in Frimley and St Peters hospitals, I believe that the CCG should carefully consider views on where post-HASU acute care should take place.

The Royal Surrey has indicated an interest in being part of the acute stroke pathway post-HASU and I strongly support that proposal.

I am very aware of the very strong public and patient concerns about the risks associated with increased travel times to the two HASUs from Guildford and places south such as Cranleigh and Haslemere, compared with travel to the Royal Surrey. These concerns are greatly reinforced by the poor performance of the ambulance service - an aspect which we hope the CCG will determinedly address.

If the two HASUs are sited as proposed, the CCG should reconsider the siting of the ASUs in the light of accessibility of Frimley and St Peters Hospitals to relatives and friends of patients post-HASU. Both are extremely difficult to get to for very many in the Royal Surrey catchment area particularly south of Guildford but also for Guildford itself. I understand that clinical outcomes are no worse for non-co-located HASU/ASU configurations than they are for co-located ones as currently proposed. I believe that In London and Manchester, for example, HASUs and ASUs are not necessarily co-located. Thus I ask that the CCG reconsider this aspect and seriously examine the possibility of an ASU at the Royal Surrey to which appropriate patients could be relocated post-HASU. Even if siting an ASU (as formally defined) at the Royal Surrey is rejected, I nevertheless believe that positioning some part of the acute stroke service at the Royal Surrey as part of the stroke pathway from HASU to home or rehabilitation in a Community Hospital, would be warranted and would meet the very strong concerns being expressed by the public regarding visiting.

Ray Rogers

National statistics for stroke death rates show Royal Surrey has the lowest

Readers will know that it has been decided that there will be only two Hyperacute Units (HASUs) in West surrey i.e. St Peters and Frimley Park and that the HASU in the Royal Surrey will close. Those people in Guildford who have a stroke will now go to ST Peters and those south of Guildford e.g. Cranleigh will go to Frimley Park.

The rationale presented is that Surrey’s death rate is poor compared with places such as Inner London which has reorganised stroke services in to large centres and closed smaller ones. Thus Surrey should reorganise similarly.

This could be taken as implying that death rates in W Surrey hospitals are all worse than Inner London and, in so far as it is the HASU in Royal Surrey which will close, some may assume that it is the Royal Surrey’s death rate which is the worse. This is not so – read on.

NHS Digital is responsible for all national health statistics in the UK. Every year it publishes data on death rates within 30 days of emergency admission to hospital from stroke. The data is given for all providers (hospitals), Counties and Boroughs. Data is for every year since 2005/06 the latest being 2014/15 (the basis of figures below).

This data shows the death rate in inner London as 14,986 per 100,000. Surrey is 2.4% worse i.e. 15,347 (the consultation states 4.8% worse).

However

• RSCH had 327 emergency admissions and 49 deaths. Death rate was 14,211. The deaths were 27% lower than would be expected looking at the country as a whole.
• ASPH had 446 admissions and 70 deaths. Death rate was 14,843. Deaths were 20% lower than expected
• FP had 827 emergency admissions and 132 deaths. Death rate was 16,412. Deaths were 9% lower than expected.

Thus, re death rates, RSCH was the best and both RSCH and ASPH death rates were lower than Inner London.

FP (which treats more than sufficient numbers to be counted as of optimum size, has most of the characteristics which are being sought e.g. 7 day 24 hour consultant presence and is a hospital rated excellent) had a very significantly worse death rate than Inner London.

RSCH is 5% better than Inner London, ASPH is 1% better and FP is 9.5% worse.

These figures do not in themselves alter the rationale for change based on London’s experience but it does show that the Royal Surrey was good at handling strokes despite whatever impression might otherwise be gained.

I am in active correspondence with the CCG about these figures but to date no explanation as the FP data has been received but note I am not knocking FP but really knocking on the head any impression that RSCH's performance has been inferior.

Charge rises by 80%

The Care Quality Commission (CQC) is the national body which among other things inspects hospital performance. It levies a charge on all health authorities to cover its costs. I have just heard that its charge to the Royal Surrey is to rise from £160,000 to £288,912. This is a rise of 80% !!!!!!! For a body which is quick to criticise lack of efficiency and any overspends, this is disgrace. The problem is that these central bodies seem unaccountable to the public. Shame on the CQC to act like this at a time when all hospitals are struggling so hard to control costs and the salary increases for health workers are being held at 1%.

Stroke Consultation
The official consultation on Stroke Services in West Surrey has commenced and will close midnight on 30 April. If you want to have a say and/or learn more there is a calendar of events on www.guildfordandwaverleyccg.nhs.uk  where you can also find information about the proposed changes.There is a survey you can fill in on www.surveymonkey.co.uk/r/StrokeConsultationWestSurrey