Official Report 816KB pdf
Our second agenda item is a very important evidence session, during which we will consider cardiac and stroke care issues that have been raised in various petitions. I am delighted that we are joined, again, by the Minister for Public Health and Women’s Health, Jenni Minto—a semi-frequent guest at our proceedings—and by Scottish Government officials working on the long-term conditions policy: Kylie Barclay, senior policy manager; Martin Macdonald, stroke senior policy manager; and Will Wood, unit head. I welcome you all. Thank you for joining us.
Our evidence session will cover recurring themes and issues that have emerged from the committee’s consideration of petitions PE1989, which calls for an increase in the number of defibrillators in public spaces and workplaces; PE2048, which calls for a review of the FAST—face, arms, speech and time—stroke awareness campaign; PE2067, which calls for improved data on young people affected by conditions that cause sudden cardiac death; and PE2101, which calls for defibrillators for all primary and secondary schools in Scotland.
The committee recently had a round-table discussion that teased out a number of the issues relating to the petitions. The discussion left the committee more convinced in some respects than in others. For example, we recognise that a lot of modern schools are being built outside of town, which is, potentially, not where a defibrillator might otherwise need to be. At the same time, there is now a map of defibrillator access across Scotland, and we are concerned that, in certain areas—particularly Glasgow and the west of Scotland—there is an obvious deficiency. I was able to put that question to the First Minister at the Convener’s Group meeting. He did not agree with all aspects of the question that we put, but he at least recognised that defibrillator access is something of a postcode lottery and that that is not ideal with regard to people’s ability to survive these issues.
Minister, do you wish to say anything by way of an introduction, or are you happy for us to go to questions?
I have a short statement to make, if I may. Thank you for inviting me to provide evidence. Addressing cardiac arrests, strokes and sudden cardiac deaths is very important to the Scottish Government, so I am pleased to be here to talk about the petitions.
I want to begin by focusing on the two petitions that relate to defibrillators. As part of the Save a Life for Scotland partnership, the Scottish Government works to improve outcomes from out-of-hospital cardiac arrest. The partnership has made significant progress since 2015, and I am pleased to say that more than a million people have been trained in cardiopulmonary resuscitation, which achieves the target set out in our strategy. Bystander CPR rates and defibrillator usage have also increased, as have survival rates, which is important.
The petitioners highlight the importance of defibrillator provision and usage. Recently, the First Minister and I were pleased to meet Rodger and Lesley Hill, who founded the DH9 Foundation, in memory of David Hill. We discussed their proposal for the placement of defibrillators in schools. The First Minister asked that the DH9 Foundation and the Save a Life for Scotland partnership provide the Government with an agreed position on the best way to increase defibrillator availability and usage in Scotland. In response, our partners have recommended taking a data-driven and localised approach to increasing defib access. That means using PADmap, which shows the location of public access defibrillators, to identify the areas where defibs are most needed, and working with local communities to place them effectively and to support increased awareness and confidence in their usage.
Our partners were also clear about the importance of cardiac responder networks in areas where fixed defib positions might not be the best approach. We are considering how we can contribute to the shared vision of ensuring that communities across Scotland are prepared and supported to respond to cardiac arrest.
Petition PE2067, which was lodged by Sharon Duncan, David Hill’s mother, focuses on improving data relating to sudden cardiac death and the conditions that are associated with it. I strongly agree about the importance of such data, and I am pleased to make the committee aware that, just yesterday, Public Health Scotland published the Scottish cardiac audit programme. That expanded report includes data on inherited cardiac conditions for the first time. In addition, the programme has been working alongside the inherited cardiac condition service along the west coast of Scotland to develop a proof of concept for a sudden cardiac death registry. It is hoped that preliminary data will be included in next year’s report. Those are really important developments that, I hope, encourage the committee and Mrs Duncan that we are working to address the challenges relating to data on sudden cardiac death and the conditions associated with it.
On the petition that relates to the review of the FAST stroke awareness campaign, I very much welcome the work that the Bundy family have undertaken. In May 2024, I met the family to discuss their campaign, and I was moved by their determination to improve awareness of stroke symptoms. Following a meeting with the family, the Cabinet Secretary for Health and Social Care asked the stroke speciality adviser to the chief medical officer to review stroke awareness education for clinical staff, which led to the development of an education package funded by the Scottish Government and delivered to more than 1,500 staff in general practices, emergency departments and the Scottish Ambulance Service. The education package also covers the less common presentations of stroke, including symptoms relating to visual field defects and certain presentations of loss of balance. We will keep our position on stroke symptom awareness under review and be guided by the best evidence at all times.
I thank all the petitioners for raising these extremely important issues. The Scottish Government and I take these matters very seriously, and I hope that I have outlined to the committee the steps that we are taking to address them.
Thank you, minister. We are at the stage in the political cycle when we are drawing our work together and looking for outcomes, because the parliamentary session ends in March.
Speaking on a personal level, I applaud the proactive engagement that you have had with David Hill’s parents, Rodger and Sharon, as well as with James Bundy and his family. The petitions were motivated by particularly personal tragic circumstances, and I know that you have invested a degree of time in engaging with them and consulting them as the way in which the Government might react and proceed has evolved. We are now at the business end of the various petitions before us.
I will start on the subject of defibrillator access, usage and community response. The public access defibrillator placement map has identified gaps. There is fantastically widespread availability, and we can see how much that has grown, as you outlined, in the course of this session of the Parliament. One of the interesting things to note is that some defibrillators do not get used very much, whereas others get used more often. That is interesting, as it points to the importance of placement and where everything should ultimately be.
People still largely rely on community fundraising and generous external sponsorship, and that has been a successful strategy, in that it has allowed for the defibrillators that we currently have to be located where they are. However, for more deprived communities—we can see them on the map, in Glasgow and the west of Scotland—is that a reasonable approach that will allow us to avoid having a postcode lottery? I am interested in how the Government plans to plug that gap. Is it through direct intervention and support, or is it through cajoling people or trying to identify people who might be available to lead efforts in communities or who might be generous enough to sponsor units in those places? Clearly, we do not want people who live in areas where there is a gap in provision to have less chance of surviving than those who live in areas where provision has been more obviously achieved.
Thank you for acknowledging the importance of listening to people with lived experience. In the role that I carry out, which is focused on public health and women’s health, the best support that we can get is from people who have experienced trauma and from those who have had positive experiences in healthcare. It is important to acknowledge that.
The evidence session that you had with Steven Short from the Save a Life for Scotland partnership, Kirsty Morrison from Chest Heart & Stroke Scotland and Kym Kestell from the British Heart Foundation was really important, because you were able to tease out a lot of detailed information from them on the work that has been going on regarding out-of-hospital cardiac arrests.
I represent Argyll and Bute, which has a wide footprint and fewer urban areas. When I was first elected, I heard about decisions on the location of defibrillators and the volume of them on islands. There was, I think, one per 1,000 of the population there, which, in theory, meant that Mull would have only three. In considering the expanse of Mull, the community recognised that they needed an awful lot more defibrillators, so they did a lot of community fundraising. I recognise that that has happened across Scotland. I commend the support that we get from the British Heart Foundation in helping people to purchase defibrillators for their communities.
It is clear that one size does not fit all, as came through in the evidence that you heard from Steven Short and Kym Kestell. PADmap is a great help in allowing us to focus on where there is need. Kym Kestell stated that people who live in the more deprived areas of Scotland are more likely to experience an out-of-hospital cardiac arrest, so there is a need for defibrillators in those areas.
You specifically asked about what the Scottish Government is doing. As you heard from Steven Short, we are active partners in Save a Life for Scotland. As I noted in my opening remarks, as a result of the recent meeting that Save a Life for Scotland had with Rodger and Lesley Hill, we received a submission from them, which we are currently considering. We will make decisions on the best way for the Scottish Government to ensure that we have the right placement of defibs across all of Scotland’s vast and beautiful geography.
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You mentioned Steven Short. He made the point that community responder units might be another way of ensuring that we access individuals quickly. How might the Scottish Government expand and sustain community responder schemes and give confidence in cardiopulmonary resuscitation defibrillator use? We all know that early bystander intervention can make a tremendous difference in getting a successful outcome. I was impressed with how he articulated that as a potential route, but how might that suggestion become something closer to an implemented strategy?
If I may, I will refer to my constituency. I met community responders at the Islay show. They have a local community set-up that is led by a couple of retired GPs, who have pulled in other people who are interested, including those in the retained fire service, coastguards and people involved in the lifeboat service. Those people are very community oriented and, as a result, they are community responders. We talked about the cost of ensuring that responders have the right equipment to allow them to respond quickly, so I am very aware of that issue from my constituency.
Part of our work with Save a Life for Scotland relates to—I think that Steven Short talked about this, too—understanding how to have the right co-ordination across Scotland, so that communities understand what they need to be able to do and how to learn. I know of a retired nurse who has supported her community by ensuring that knowledge and training are maintained so that the community can respond to someone having an out-of-hospital cardiac arrest.
It is very much about engaging with communities and with all the Save a Life for Scotland stakeholders, including the Convention of Scottish Local Authorities. I know that Davy Russell asked about how local community areas and planning groups could support the work. That collaboration, which Steven Short talked about, is very important.
I know that you had dialogue with Steven Short about training young people and those of us who are slightly more advanced. I remember getting CPR training in the brownies and in the guides—and, more recently, at a walking football event in Glasgow. He commented that, as long as you know the basics, being prompted by the call handler as to what you should be doing will give you confidence.
All the stakeholders need to be involved, including the Scottish Ambulance Service and the Scottish Fire and Rescue Service. As I said, in my community, on Islay, other people have been pulled in. Through our connection with Save a Life for Scotland, the Scottish Government is very much looking at the proposals that it has sent us.
Fergus Ewing will pursue some of the training issues later.
You were in the brownies later than I was in the cub scouts—we just did a lot of marching.
My questions are on sudden cardiac death research and data co-ordination. How will the Scottish Government ensure that existing data on PAD locations, out-of-hospital cardiac arrest incidents and cardiac outcomes is shared effectively, is accessible and is used across all relevant agencies to support strategic planning and improve survival rates?
Last Friday, I was at Public Health Scotland’s annual review. PHS collects a wealth of data across healthcare and, as I indicated in my opening remarks, the Scottish cardiac audit was published just yesterday. It includes some additional information on out-of-hospital cardiac arrests—this is the first year that that has been included, and we recognise the importance of it. As you pointed out in your question, that will allow us to plan better for the pathways and the support that we can give to communities.
I am pleased that PHS is able to collect that data. We are hoping that the next stage will be that health boards feed in directly to that process, as opposed to there being a two-stage approach. That is really positive and it will not only help the Scottish Government but help health boards to understand more about the needs in their communities.
My second question covers part of that. What steps will be taken to strengthen research into sudden cardiac deaths, inherited cardiac conditions and behavioural barriers to bystander intervention, so that the evidence can guide policy development, public health campaigns and targeted interventions?
There is quite a lot in that question. Kym Kestell from the British Heart Foundation Scotland gave the committee good evidence on the research that the BHF is doing, which the Scottish Government is very pleased to support. We also have the Chief Scientist Office, which is in charge of research into health in Scotland, and the chief scientist is very open to receiving applications from organisations and universities to undertake specific research into heart conditions. Alongside the data, the research that we can undertake in Scotland, given our population, is really important.
To follow up on the point about Kym Kestell’s evidence, she said that there are potentially thousands of defibrillators that we do not really know about, as they are not registered, and that that provision could be mapped and logged. What can we do to encourage that process to take place?
I think that we, as MSPs, all have a responsibility in that regard. A few months ago, there was a debate in Parliament about that, explaining to members the importance of ensuring that the defibrillator in their area is logged on to the circuit. As Steven Short explained in his oral evidence to you, that is how the Scottish Ambulance Service can direct people to the closest defibrillator in the area.
Last Friday, I was in Oban, visiting the Happy Wee Health Club. Outside the gym, there is a defibrillator on the wall. We need to ensure that it is well known where the defibrillators that are dotted around communities are situated.
I agree that MSPs and others, including members of Parliament, could do something to help to promote that. Is there a graphic available that we could, for example, post online to encourage community groups to register a defibrillator if that has not already happened, or to check whether their defibrillator is registered? If there is not a graphic, could something be produced that we might endeavour to use as a tool to try to encourage registration?
We usually tweet and do other things during awareness-raising campaigns, but I am very happy to take away that suggestion. Members also have access to the PADmap tool, and it is possible to tweet the URL for that.
I think that it would be a positive outcome if the committee could encourage our parliamentary colleagues to involve themselves in that. There is probably not a parliamentarian who has not had cause to engage with this issue during their time in Parliament, but members are perhaps not quite sure thereafter what more they can do. I think that something constructive, such as I have described, would be appreciated.
Absolutely—it is a great idea.
Given the United Kingdom National Screening Committee’s planned review of evidence on population screening for sudden cardiac death, what role might the Scottish Government play in that regard? Moreover, what additional steps is the Scottish Government taking to improve data collection, classification and public reporting of sudden cardiac deaths, particularly in young people?
As you know, the Cabinet Secretary for Health and Social Care and I have written to the UK NCS, which is an independent body, and we understand that, over the next three years, it will be reviewing evidence. The evidence must be robust and peer reviewed, so we are pleased that that is part of the screening committee’s work programme.
We are already considering what we can do once the UK NCS makes a decision. It was clear, when Kym Kestell answered a question on screening, that it is not just about screening; we need to ensure that we have the pathways in the various health boards to ensure that they can support people who are screened and might have a condition. We do that work regularly with health boards.
With regard to data, I touched on the Public Health Scotland Scottish cardiac audit, which was released yesterday. There is an iterative process to ensure that we are collecting the right data, and the scope has been extended, as this is the first year in which the audit has contained additional information on congenital, if I can use that word—
It is inherited.
It contains additional information on inherited cardiac conditions.
I appreciate that there will be an independent review, but three years is an awfully long time. What is the Scottish Government’s current assessment of how effective screening might be in preventing sudden cardiac death? I am thinking about any issues with false positives or negative results as a consequence of screening.
When the First Minister and I met the Hill family, one of the outcomes concerned the need to understand clearly what sportscotland is doing. Sportscotland has some guidelines, and Scottish Rugby and the Scottish Football Association have clear pathways to ensure that people who are participating in sport have the right healthcare monitoring that they need. In that meeting, I was struck by the work that the Hills have been doing on monitoring young children who have been playing sport. We have been looking at that in preparation for any change in the UK NSC guidelines.
To follow up on Mr Golden’s question, three years is a long time. Has the Scottish Government recommended that the UK NSC speed up the review?
As I said, the UK NSC is an independent body. Our chief medical officer is represented on it, along with the other three chief medical officers. I think that the fact that we have written to the UK NSC emphasises the Scottish Government’s interest in its work timetable. As I said, however, the UK NSC makes decisions based on robust evidence that has been peer reviewed, and we need to ensure that that process is followed properly and correctly.
10:00
I can understand that, but the UK NSC’s submission of 9 May 2024 said that there was not enough evidence because there is not a predictive test, there is
“insufficient understanding of the genetic risk”
and it does not really know what to do with people after screening anyway. It was all a bit negative, do you not think? The UK NSC is really saying that it does not really know much about it, there is no way that it can find out what to do about it and it does not know what to do about it, even after screening. For a national body to come up with three reasons for doing nothing, all of which are an admission that it does not know, seems to be lacking, and it is not what we would expect from a distinguished national body with eminent people serving on it.
I understand the concerns that you have raised, Mr Ewing. That response prompted us to start thinking about, if that decision was changed, what we need to do in Scotland to work with clinicians to ensure that we have the right processes. Those questions prompted us to review whether we would change what we do if the UK NSC’s decision changes in three years.
You will be aware of the experience in Italy, which has had, for a long time, screening for those who are involved in sport, and it has led to an astonishing 89 per cent reduction in the number of young people who have subsequently died of cardiac failure. I take it that that is part of the subject of the review. That seems to be a compelling success story for that country, particularly for the families of those whose children are with us still, as opposed to elsewhere and here, where that is not the case.
It is sometimes difficult to quantify the numbers in relation to those who are screened, but it seems to me that screening places a premium value on the life of young people, particularly at an age when we know that they are more likely to engage in that kind of sport. The committee was very impressed with that.
Yes, and I was, too. That is why it is important that Public Health Scotland is now gathering the inherited cardiac conditions information to allow us to shift, and is also gathering information from sportscotland about what is done through sport. As I said earlier, the information that the Hill family gave us at the meeting with the First Minister was very compelling and we are looking at that.
Sorry for interrupting you, Mr Ewing.
No, I am grateful for your intervention, convener, because you reminded me about the submission that we received from the consulate general of Italy on 13 March 2025. Perhaps I could ask the minister to have another look at that.
Should the UK NSC, which we have not heard from since April 2024, also not have a good look at the evidence from Italy? It is pretty overwhelming. Its screening programme has been tremendously effective, particularly for young and active athletes. Surely it would not be difficult to implement a pilot screening programme for young athletes, perhaps via the various sporting associations.
Minister, I entirely accept your commitment, I am impressed by your general approach and I do not mean to give you a hard time today, but we all feel that we have not quite bottomed out this topic yet. To do justice to the petitioners, we are willing to work with you to try to get something done, unlike the UK NSC doing the square root of diddly-squat until the end of the decade.
I appreciate the questions and it is important for us to get the right healthcare results for Scotland. Robust questions are fine, Mr Ewing, and if I cannot answer them, I am happy to respond in writing.
I will take away what you have just said about reviewing the evidence from Italy. I believe that the work in Denmark was also highlighted to the committee. I am content to have a look at that and respond to the committee with our thoughts. If you will allow me, I will gather some clinical views on that, too.
You must be clairvoyant, minister, because I was just going to ask about Denmark. I do not have a clairvoyant relationship with many ministers. [Laughter.]
Extrasensory perception, and all that.
I would be happy to begin the relationship, which would be very exciting.
I suspect that that would be a matter of some good fortune for ministers, Mr Ewing. [Laughter.]
Thanks for that, convener.
To be serious, Denmark was cited as an example of good practice for training, because it embedded mandatory CPR training in schools. By law, kids must receive the training at an early age. There is some contra-evidence in research that has been brought to our attention but, nonetheless, as raised by Kym Kestell in the British Heart Foundation’s submission, Scotland is the only UK nation where CPR is neither mandated in the school curriculum nor tracked through reporting. I know that each local authority says that it is committed to doing that, but would it not be simpler if we mandated it, so that everyone has to do it? We would know exactly where we are and we would be able to judge the outcomes by virtue of a clear law, rather than by an aspiration that we hope that local authorities will do nice things at some point in the future.
I am sure that Mr Ewing is aware of the impressive and thought-provoking time for reflection contribution that we heard from Cameron McGerr in the chamber a few weeks ago. I happened to be sitting next to the Cabinet Secretary for Education and Skills and the Cabinet Secretary for Health and Social Care. The three of us have written to Cameron. I was hoping to have heard where the matter had got to, but we are hoping that a group of us, if not all three of us, will be able to meet Cameron to hear more from him about the importance of ensuring that young children receive CPR training, as he recognised.
I have also had the privilege of meeting a father and son. The son was able to save his father’s life because of the CPR training that he had received in early secondary and later in secondary school. I recognise the importance of that training. As you will appreciate, education does not sit in my portfolio, but I am content to speak further with the Cabinet Secretary for Education about the issue. We can come back to the committee once we have met Cameron McGerr.
Again, the minister must be capable of reading my mind, which is an alarming prospect for her. I was going to ask about Cameron McGerr because it was brought to the committee’s attention that the Cabinet Secretary for Education and Skills wrote to him after he delivered his time for reflection contribution and offered to meet him. You have already alluded to the fact that the meeting is being pursued, for which I am grateful. Once it has been pursued, I wonder whether you could alert the committee to what is happening.
I appreciate that you do not have portfolio responsibility, because the matter falls under education, but to get back to the real topic, would it not be simpler if every child had to learn CPR at school? I think that I learned it when I was 45, as it just happens that I was in a mountain rescue team. It was a strange way to learn it, although I suppose it was better than nothing. It shows the random way in which people are learning about CPR. Would it not be best that, like Denmark, every child learns about CPR in primary school?
I am content to take that away and have a conversation with the Cabinet Secretary for Education and Skills about it. You are right that, in different areas of Scotland, different training is given. I have highlighted that people from the Royal National Lifeboat Institution may be going into schools, and I know that the St John Ambulance service has a very good plan to go into schools to provide support with that. I completely understand where you are coming from.
Minister, I hope that this suggestion, which follows on from Mr Ewing’s, will also be helpful. I have a Union of European Football Associations C licence for football coaching. As part of the journey to that, there is an online element of first aid training, but CPR is not included in it. Every football coach in Scotland must do the level 1.1 coaching course, and first aid is part of that. Will you commit to engaging with the Scottish Football Association and Scottish Women’s Football on CPR being included as part of that coaching pathway? The point about schools is a good one, and my suggestion is another mechanism through which we can get the message out there in a structured environment.
I would be happy to have that engagement. From a public health perspective, we have very good relationships with Scottish Women’s Football, which has supported us with an anti-vaping campaign as well.
It is great that young people are learning CPR because it seems that a skill, once learned, is a skill retained. At our previous meeting, I rather self-deprecatingly pointed out that those of us who are slightly older were actively trained in CPR here in the Parliament, but that that knowledge has perhaps ebbed with the passage of time. I do not know whether I am somebody of an age who should hope to be saved in the event that anything happens or whether I am still somebody who should actively be trained to save others. I know that there were some prompt notes. Steven Short said that I should be reassured that the training that I received is probably retained instinctively and that, with the prompt notes, I would find that I was able to participate again. However, can anything more be done to refresh skills in those who took the time to invest in training in CPR in the first place?
At the start of this evidence session, we talked about the importance of community engagement and ensuring that the community has guardians—that is how Steven Short and others described it. That ensures that, in the community, there is continual refreshment of skills. As I said earlier, when someone is on the phone to the call handler, they will get prompts to tell them what to do.
I would suggest that, if you fancy refreshing those skills, there are a lot of events happening around Scotland. I highlighted the walking football event that I was at. St John Ambulance was there, giving support alongside the Stroke Association—I think, although it might have been Chest Heart & Stroke Scotland. At a lot of events, and certainly a lot of the agricultural shows in Argyll and Bute that I go around, there is an opportunity for people to get refresher training. There are also good online resources on the Save a Life for Scotland website.
Thank you for that. If you are seeking to encourage me to attend events where exercise is involved, you will have the whole-hearted support of Mrs Carlaw, even if I am slightly more reluctant.
Before I move on to the next theme, I note that, in a previous answer, it was highlighted that there could be better coverage of defibrillators in deprived areas. Recently, in my constituency, I was involved in three charity days where they raised—I cannot remember the actual sum, but it was a few thousand pounds. The funding was matched and they raised enough in one day to get their defib. However, that is much harder to do in a deprived area where people are worried about putting dinner on the table for the kids. Is there a mechanism for putting in matched funding rather than the community having to do it, given the situation that people are in in poorer communities?
That important question ties into a question that you asked at the previous meeting as well. I know that you recognise that local authorities know their communities and who the key drivers are in different parts of their communities, whether that is the more deprived areas or the less deprived ones. Partnership working is definitely happening, and COSLA is part of the Save a Life for Scotland partnership, as you know.
10:15Another important thing, which Steven Short touched on, is that businesses are often willing to get involved in supporting fundraising, as is the British Heart Foundation. As I said, we are looking at a paper that was worked on at the most recent Save a Life for Scotland meeting, and we will be taking decisions based on that.
I will now ask my questions on the theme of public awareness and education around stroke. Given that only half of stroke patients received the full treatment bundle last year, which fell short of the national performance targets, what plans does the Scottish Government have to increase investment in stroke services, including for workforce capacity, infrastructure and access to timely, evidence-based care?
I was very disappointed to read the statistics that came out recently on the stroke bundles. I agree that improvement has to be made.
Just last week, I chaired a round table of all the stroke leads from the health boards across Scotland, at which we talked specifically about door-to-needle time as a major concern. We have considered how health board staff are configured and we have helped boards to introduce nurses who will specifically support people who could be presenting with stroke symptoms. I think that I am right in saying that NHS Lanarkshire has made really good improvements there. At the meeting last week, it was great to hear about what NHS Lanarkshire has been able to do. The other health boards heard about that and they can consider the changes that they could make. The Scottish Government has provided some funding to allow additional training for nurses across the health boards.
As you will know, the Scottish Government provides funding to health boards directly. The total health budget is about £21 billion. Of that, about £15 billion goes directly to health boards, and it is for them to make their decisions on how to allocate that among the various conditions that they have to support.
Having met the Bundy family and representatives of the Stroke Association and Chest Heart & Stroke Scotland, I felt very strongly that it was important for each health board to have a stroke lead and for me to meet them regularly. We also have a stroke specialist in the Scottish Government, who is part of the chief medical officer’s team. He engages regularly with the stroke leads to ensure that we can improve, because that is what we have to do. You are absolutely right that we have to improve the statistics.
There is such a big disparity, given the 50 per cent figure. Is the target aspirational rather than being a challenging but achievable one? Perhaps you will need to consider that.
It is a target. If a target is challenging, that is great, because it challenges people to ensure—
That is what I am saying. Is the target an aspirational one that cannot be achieved, as opposed to one that is still achievable? That is what is needed to drive staff on.
I absolutely agree. The targets will have been set with clinical advice and guidance. Targets should be a stretch, because we want people in Scotland to be healthy and to maintain healthy lifestyles. I know from the people who I have met who are living with stroke that some have had better journeys than others. That is how we learn. It is through sharing those stories widely among MSPs and more broadly across Scotland that change can happen. I was very heartened by the meeting that I chaired last week, because I heard a group of people who have the same determination to reach those targets.
What actions is the Scottish Government taking to improve awareness and recognition of the full range of stroke symptoms, beyond those that are captured by the face, arm, speech, time—FAST—acronym, among the public and healthcare professionals? Does the Scottish Government plan to support a pilot study to test the public comprehension and clinical impact of the balance, eyes, face, arm, speech, time—BE FAST—approach? Will findings from NHS Forth Valley’s adoption of BE FAST be incorporated into future policy decisions?
I have had a number of conversations about that with officials and third sector organisations such as Chest Heart & Stroke Scotland and the Stroke Association. As you will know, Chest Heart & Stroke Scotland ran an awareness campaign either late last year or earlier this year that was based on the FAST guidelines.
I mentioned in my introductory remarks that, as a result of his meeting the Bundy family, the cabinet secretary asked the chief medical officer to do a piece of work on the issue. As a result, we have provided and funded an education resource—which 1,500 people from emergency departments, general practice and wider healthcare have gone through—to ensure that people are aware not only of the FAST symptoms but also of those that are not in that acronym, which can be around balance and visual impairment. That work has been done and it is continuing.
What causes you to hesitate on the BE FAST programme, minister?
We need to be aware that the FAST acronym is very well known. Bringing in the “BE”—the balance and the eyes—could produce some false positives, which we would be concerned might impact on clinicians’ ability to treat. That is why, in the additional training resource, we have been very clear that we are focusing on FAST, but we are also ensuring that people are aware that there could be other symptoms. The evidence and the discussions that I have had with the Stroke Association and Chest Heart & Stroke Scotland show that their views tie in with that.
Will that continue to be reviewed as we see the pilots?
Most definitely. As Davy Russell highlighted, a pilot is happening in NHS Forth Valley—we have not had any outcomes from it yet—and I note that NHS Ayrshire and Arran is also considering it.
I am grateful for that. We do not want an impression of intransigence to be given. Instead, we could say that BE FAST is something that others might have moved to at this stage and that, although we do not dismiss the possibility of its value, we do not think that it is the right step to take at this point. There is a distinction between those two things and how they are coloured.
I absolutely agree that there is no intransigence. Davy Russell pressed me on the targets, which are there because we expect to meet them. However, as knowledge changes, we need to be flexible enough to ensure that we provide the people of Scotland with the right support for their health.
I want to pursue that point and the questions that Mr Lawrence posed on BE FAST, which includes visual and balance problems, as opposed to FAST. It is a fact that FAST does not necessarily pick up those eye and balance symptoms of the stroke that caused the death of the person concerned, so we are talking about people dying.
I have a couple of questions on the Forth Valley pilot. When will it be completed and reported on? Will the report cover the reservations about moving from FAST to BE FAST? To put it a bit too crudely, the reservations were that—bear with me—the public were too stupid to understand BE FAST because there is too much information there for it to grasp. That is basically what the experts say. FAST has four things to remember whereas BE FAST has six, and six is too many. I do not think that that is the case. Can that be specifically analysed in the Forth Valley study? If not, the pilot will be a bit of a waste of time.
The second criticism that you made, minister, was that BE FAST might result in a large number of people being referred to a hospital for no purpose because there is nothing wrong with them, which would cause an increase in workload in already stretched health services. That is a practical point, and I accept it.
Will those two arguments be tested in the pilot? If not, a sceptic would say that we are not really much further forward and that we have missed the opportunity for the pilot to analyse whether those two objections are real or overstated by clinicians and experts.
That is a very fair question. As NHS Forth Valley is taking forward the pilot, I have no information on when it will be complete or when we will get the report. However, your questions are all on the record. Martin Macdonald is here with me today and we will converse with the health board to understand what it is doing, where it is in the pilot and when we can expect the report.
We are all in favour of conversing.
Do you have anything else to add, minister?
I would just like to say thank you. I appreciate the evidence that you gathered in your previous evidence session.
Thank you for your positive engagement on the issues.
We have been considering four petitions today. Occasioned by a situation that tragically affected her family, petition PE1989 was lodged by Mary Montague—who happens to be the provost of my local authority, although she lodged the petition prior to that happy event—and it calls for an increase in defibrillators in public spaces and workplaces.
Petition PE2048, which was lodged by the Bundy family, calls for a review of the FAST stroke awareness campaign. The petition was motivated by tragic circumstances that affected the family.
Petition PE2067, which calls for improved data on young people affected by conditions that cause sudden cardiac death, was lodged by Sharon Duncan, the mother of David Hill, because of the personal circumstances that the family endured.
Petition PE2101, on the provision of defibrillators for all primary and secondary schools in Scotland, was lodged by Peter Earl on behalf of Troqueer primary school because of the work that the school has done.
I commend all the petitioners for enabling the committee to thoroughly and properly air the issues, and I thank the minister for her engagement.
Are members happy to consider the evidence that we have heard today at a future meeting?
Members indicated agreement.
I thank you and your colleagues again, minister. I will suspend the meeting briefly.
10:28 Meeting suspended.Next
Continued Petitions