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