Stroke Care in South West Surrey

On Friday (30th June 2017) I had a very good meeting with South East Coast Ambulance Service (SECAmb) CEO Daren Mochrie, NHS England National Stroke Director Professor Tony Rudd and others to discuss the proposed changes to stroke care which are worrying a number of people in Haslemere. Haslemere and Elstead residents were represented by Cllrs Robert Knowles and Jenny Else.

In short there appear to be two separate issues. One is the changes to stroke care which involve the move to hyper acute stroke units. These involve concentrating stroke care in a smaller number of HASUs where the care is 24/7 and likely to lead to better outcomes (in London the same change has been proven to save a number of lives every year). The trade-off is between a marginally longer time to get to hospital (about ten minutes more for Haslemere residents) but a more reliably high standard of care when you get there - for which consultants at the meeting said there was anecdotal evidence.

Frimley and Ashford St Peters would the HASUs serving SW Surrey constituents, with a pending decision as to whether the Royal Surrey should provide after-stroke care. My sense from the meeting was that most people support this change but I asked for an independent assurance from Professor Tony Rudd, the most senior stroke consultant in the NHS, that he is happy with whatever final decision is taken in September.

Where there is much greater concern is ambulance response times. The current target says ambulances must give an eight minute response to the most urgent calls 75% of the time. The trouble with a target like this is it can discriminate against more rural areas if an ambulance service prioritises bigger conurbations where they are more likely to get to patients quickly and therefore hit their target. For strokes, in Haslemere's case, the average response time is 15 minutes, with 90% of people seen in less than 26 minutes. This is an issue for many parts of the country which the NHS is actively considering with the Ambulance Response Programme pilots and I hope we will find a way to resolve a sensible way forward soon. But whatever is decided nationally, Daren Mochrie is going to come back to me with some specific plans for Haslemere.

But my take on this is one that is relevant for the whole NHS and not just for Haslemere: the key measures should be outcome measures for patients rather than an arbitrary target. What matters is not how long an ambulance takes to respond to a call but how long it takes from the moment a call is made to the moment a patient starts appropriate treatment. So I will be finding out from the NHS a) whether we collect this information for strokes and heart attacks and if not b) whether we can collect it. Then we need to decide what the best way to improve it is - for which setting the right targets for the ambulance service will be vital.

And by the way happy 80th birthday for the 999 service (for last Friday).