What is the Surrey Stroke Services Review? Stroke services in Surrey

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1 What is the Surrey Stroke Services Review? Stroke services in Surrey A stroke is caused when the blood supply to the brain is interrupted, usually because a blood vessel bursts or is blocked by a clot. This cuts off the supply of oxygen and nutrients, which can damage the brain tissue. The effects of a stroke depend on which part of the brain is injured and how severely it is affected. Each year, around 3500 people in Surrey use stroke services in hospital. Some of these have had a stroke, others have conditions that seem similar to strokes. During the first 72 hours after a stroke, people should receive highly specialised care within a hyper acute stroke unit (HASU). After that, they can be looked after by specialist stroke doctors, nurses and therapists in acute stroke units (ASU). There are currently five hospitals across Surrey caring for people who have had a stroke. These are East Surrey Hospital, Epsom Hospital, Frimley Park Hospital, the Royal Surrey County Hospital and St Peter s Hospital. After people have received the care they need in hospital, they might go to a community hospital to continue their rehabilitation, or they might go home or to a care home. When people are in the community, they receive help such as physiotherapy and speech and language therapy, depending on their individual needs.

2 Why we are reviewing stroke services? The National Stroke Strategy was published in The strategy highlighted that providing better care for people with stroke could save lives, reduce levels of disability and help use services more appropriately. Local doctors, nurses, therapists and others do a good job, but we are always keen to keep providing better care. For example, a new thrombolysis service was set up to provide clot busting drugs to suitable people. This is available 24/7 across Surrey. We know there is a need for even more improvements. Stroke services provide data so their performance can be audited against national standards. This is called SSNAP (Sentinel Stroke National Audit Programme). We know from the SSNAP data that we could organise services in hospital and in the community better. One of the key measures in SSNAP is how quickly you receive care on the acute stroke unit, and we have room to improve here. The began in late 2014 to find out how to provide the quickest, safest and most effective services for local people. The reasons for reviewing stroke care are: to improve health outcomes for people in Surrey to respond to the views expressed by local service users and clinicians to ensure specialist services are treating enough people to maintain the required levels of expertise, thus providing the highest quality clinical care to meet national guidelines and apply best evidence to bring Surrey services in line with the enhancements happening nationally to future-proof services against population growth and workforce changes to respond to peer reviews of community services and performance data about acute services

3 How are we reviewing stroke services? In the NHS, clinical commissioning groups (CCGs) are responsible for planning and buying services. There are five clinical commissioning groups in Surrey. All of these organisations are working together and with neighbouring clinical commissioning groups (North East Hampshire and Farnham), hospitals and organisations providing services in the community to complete a comprehensive review of stroke services. This includes from the time a stroke happens right through to after people are back where they live. The review is being led by the Stroke Change Board which includes: People who have had a stroke, and their families Specialist stroke doctors, nurses, radiologists and therapists from local hospitals The clinical commissioning groups Social care The ambulance service The voluntary sector and groups such as the Stroke Association So far the review has: Asked people who used services what they think Worked with the Stroke Association to understand people s views Held events with service users, doctors, nurses and other professionals Looked at research about stroke services Collected data from hospitals, community services and the ambulance service Peer reviewed community services Worked with national experts to review our data Learnt from similar reviews and changes in other areas

4 What could be improved in Surrey? We know that getting prompt care from highly specialised professionals can make a difference to people s lives. There are five hospitals providing acute stroke services in Surrey. At the moment: more than one third of people in Surrey do not get admitted to a stroke unit within the best practice target of four hours; only one of the five hospitals sees at least 600 people with a stroke every year. This is the minimum number suggested for keeping skills up-to-date; only one of the five units has seven-day consultant ward rounds; there are big variations in whether people are assessed by a specialist stroke consultant within 24 hours after a high risk mini-stroke (ranging from 66% to 91% at the different hospitals). people who have had a stroke are not always getting the follow-up support they should after they leave hospital. Sometimes people do not have a six month or annual review or cannot access psychological support. By making improvements we can help to get the best possible health outcomes for people in Surrey, respond to concerns expressed by service users and clinicians, and future-proof services in line with population growth and workforce changes.

5 What will happen after the review? The review will run until early During that time, the NHS and partners will be seeking people s views about what to do next. From the middle of 2016, the aim is to provide improved services. All of Surrey s CCGs are planning to maintain high levels of investment in stroke services. The work to improve stroke services is not aiming to reduce the funds spent on stroke. It aims to find more effective and efficient ways to use resources so that more people who have a stroke get the very best care. The CCGs will make decisions about the priorities for improvement. These decisions will draw heavily on the experience of local people and the evidence available. Because stroke care is highly variable across Surrey, not everyone is receiving the same quality of care. Enhancing care in line with national and international best practice will make sure that people receive an equitable level of care.

6 What are the next steps? So far, the Stroke Review has looked at, checked and analysed data about stroke services. We have compared what is happening in Surrey with the National Stroke Strategy and other evidence about good practice. People who have used services have told us that: There are lots of good things about the care in hospital and the community. It is important to continue care on for longer, rather than stopping suddenly. It is important not to have to wait too long for services or in between appointments. GPs could help more when people return to where they live. The family members and friends of people who have had a stroke need help too. We want to hear more about people s priorities so we are asking more people to share their views. One of the most pressing challenges is balancing the expectation that people need to reach a HASU quickly if they have a stroke versus the clinical imperative to make sure the right staff are available to treat patients with sufficient numbers to maintain their skills. While quick access to a HASU is crucial, evidence suggests that as long as the person receives treatment within 4.5 hours of the onset of symptoms, the most important factor affecting their chances of recovery is the skill of the team that cares for them. National clinical experts say that it would be preferable for people to spend up to 45 minutes being transported if it meant they could go to a HASU that met all the recommended standards compared to having a shorter journey to a hospital that did not meet all the standards. Between August 2015 and February 2016 we will be asking the public, people who have used services, staff, community groups, NHS organisations, the Council and others for their opinions about what is working well and not so well. There will be surveys and listening events, and groups will be approached to share their views. The CCGs will make a decision about possible changes in March 2016, so improved services can begin as soon as possible.