People who have a stroke can recover well, leading happy healthy lives. Getting fast high quality care and good ongoing support can make a real difference. In Surrey, about 3,500 people every year use hospital stroke services. After hospital, people receive help in their communities. Surrey’s doctors, nurses, therapists and others do a good job and the NHS wants to make things even better. Improving stroke services could save lives and reduce disability. That’s why the NHS is working with local people, community groups and others to review stroke services. The review is taking place until March 2016.
Stroke care 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.
Why review stroke services?
The National Stroke Strategy was published in 2007. 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 Surrey Stroke Services Review 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 reduce people in Surrey's risk of death or disability after they have a stroke
- 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
- to prevent more strokes from happening in the first place
What could be improved?
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 and to run an efficient service;
- 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 Transient Ischaemic Attack (known as a TIA or ‘mini-stroke’) (ranging from 66% to 91% at the different hospitals); and
- 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.
People who have used services have told us that:
- 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.
- The help and support that GPs can provide people when they return to where they live is crucial.
- The family members and friends of people who have had a stroke need help too.
One of the most pressing challenges is balancing the expectation that people need to reach a hyper acute stroke unit (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.
At present, the types of care people will receive in their communities when they return from hospital varies widely across Surrey. Evidence suggests that providing early ongoing support in people’s own homes or community venues can help people to leave hospital more quickly and regain their independence. Looking at how to organise services in the community is an important part of the Surrey Stroke Review.
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.
The Surrey Stroke review wants to know what matters most to you.