The final item of business is a members’ business debate on motion S4M-12093, in the name of Margaret Mitchell, on Chest Heart & Stroke Scotland’s outstanding support for survivors. The debate will be concluded without any question being put.
Motion debated,
That the Parliament recognises what it considers Chest Heart & Stroke Scotland’s outstanding support for stroke survivors; understands that it provides information and support through its Communication Support Services (CSS); notes that there are six CSS coordinators in its Central West area, who in turn support 17 communication stroke groups, such as the Young Stroke Survivors group, which meets fortnightly in Coatbridge; understands that this group believes that GPs need to be more aware of the signs that might be an indication of a patient either having had a minor stroke or of being at high risk of a stroke; understands that all of the groups raise awareness of the common effects of strokes, including what can be hidden conditions such as tiredness, memory loss, lack of concentration and communication difficulties, and highlight the availability of physiotherapy and speech therapy for survivors, and commends Chest Heart & Stroke Scotland on its community-based services.
17:06
I am delighted to welcome the members of Coatbridge young stroke survivors to the chamber this evening. I had the pleasure of meeting that inspirational group towards the end of last year. At that meeting, through listening to the members’ accounts of what happened to them, I began to understand the varied issues associated with strokes that survivors face. I discovered, for example, that those who have had a stroke often then experience hidden conditions. Those will be different for each individual, but tiredness, memory loss, a lack of ability to concentrate and communication difficulties are common.
Given that, stroke survivors support groups, such as the ones provided by the charity Chest Heart & Stroke Scotland—CHSS for short—play an immensely important role. Those groups provide the opportunity for survivors to meet and it can be a tremendous relief for a survivor to know that they are not alone and that someone else understands how they feel and what they are experiencing.
The charity also helps stroke survivors to understand and come to terms with new physical and other limitations that can be a product of the stroke. CHSS community stroke groups are self managed, so, although they are linked to CHSS, that allows them the flexibility to reflect local interests and diversity. The groups help their members to take part in activities in their local community. In fact, when I heard about all the Coatbridge members’ activities, including abseiling, I felt like a definite coach potato by comparison.
The charity’s community stroke services are provided in partnership with the national health service, which, in turn, helps to establish a link between community services and speech, language and physiotherapy. It is absolutely essential that stroke survivors have access to those services as soon as possible after having a stroke. CHSS says that 110 communication support services across Scotland can offer either one-to-one or group support, which helps to rebuild survivors’ communication skills—an often daunting and formidable task. Despite that, the sad and unpalatable truth is that adequate physiotherapy and speech therapy are, in far too many cases, not available. Survivors talk of different levels of provision across health board areas.
That anecdotal evidence was confirmed by a freedom of information request that I lodged with health boards and local authorities, which revealed either different levels of provision or, more worryingly still, a complete inability to specify exactly what provision was available. Surely that lack of adequate provision could and should be tackled as a priority. It makes sense not only from the point of view of preventative spend, because the difference that it can make to the quality of life of survivors, and of their spouses and families, whose lives are also turned upside down, is beyond measure.
In that area, CHSS offers invaluable support to family members who can, virtually overnight, find themselves cast in the new, stressful and intense role of being a carer to a stroke survivor. That aspect is often overlooked, as I heard in graphic, compelling and deeply disturbing detail yesterday when I met some South Lanarkshire carers of stroke survivors. The common thread in their stories was the lack of support that was available from the social work department, especially if the stroke survivor was not hospitalised for any length of time and/or owned their own home.
The same story was repeated: survivors and their carers had been left to flounder and callously told to make the arrangements to source and commission the necessary adaptations, and then had to pay for those adaptations to allow them to live in the familiar and comforting sanctuary of their own home. That happened at a time when carers’ stress levels were off the scale, especially if the carers were having to cope not only with their new demanding role but with financial difficulties resulting from a loss of employment, which could mean that they have to sell their home.
Hidden conditions such as extreme tiredness have a knock-on effect for survivors as they attempt routine tasks such as accessing a large supermarket. Often, if they are forced to park several hundred metres from the entrance, although walking the distance might be possible, it is slow and laborious to the point of not being feasible given that extreme tiredness and exhaustion can often set in suddenly.
I ask members to imagine the humiliation of a stroke survivor and blue badge applicant who was asked to attend the North Lanarkshire Council headquarters in Motherwell for an assessment. On presenting, he was met by an occupational therapist and told to follow her to her room. She then proceeded to set off at a pace round the circular lobby. The survivor protested that he could not keep up and that he needed to rest. He was ignored, and he soldiered on to find himself back where he started. Apparently the assessment had been completed, and he was refused a blue badge.
I do not believe for a second that any politician would condone such degrading treatment. When I made the director aware of what had taken place, he was appalled, and he confirmed that a proper reassessment would be carried out. However, the callousness and dehumanising behaviour on the part of some local government officials—including social workers—who are usually far down the chain of command must be addressed, and checks and balances must be put in place to ensure that stroke victims get a fair hearing.
On a more positive note, the awareness-raising acronym FAST is designed to help the public to recognise that someone may be having a stroke. The F stands for face: if one side of the face is drooping, that is a possible symptom. The A stands for arms, and the test is to see whether the person can lift both their arms. The S is for speech: if it is slurred then, together with the above signs, the T means that it is time to call 999.
Early treatment and recognition of a stroke occurring, where blood supply to part of the brain is being cut off, are clearly crucial to minimise long-term damage. However, too many of the survivors at CHSS report that general practitioners are not picking up the signs that indicate that a patient is either at risk of a stroke or having a minor stroke that could lead to a more severe stroke.
Although the FAST campaign is excellent, much more needs to be done to train GPs to recognise other stroke symptoms, which can include high cholesterol, high blood pressure and/or diabetes.
To put the scale of the problem in perspective, every 45 minutes someone in Scotland will have a stroke. It could be anyone at any time. That is why the issues that tonight’s debate raises are so important and why they could, if they are addressed, make a monumental difference to the lives of survivors and their carers, who deserve the Parliament’s support. I look forward to the minister’s response.
17:14
I start with an apology to you, Presiding Officer, and to Margaret Mitchell and other members, as I will have to leave the debate early for another engagement.
I am grateful to Margaret Mitchell for bringing the debate to the chamber. As the convener of the cross-party group on heart disease and stroke, I am very much aware of the story that Margaret Mitchell has presented to the Parliament this evening.
Chest Heart & Stroke Scotland provides the co-secretariat for the cross-party group. We often hear stories about survivors at the cross-party group—they all have their own individual stories.
A lot has happened, and a lot of good work is going on. The cross-party group was instrumental in developing the stroke charter, which was first proposed by Helen Eadie. When Helen died, I undertook to take the charter forward with a sub-group. The charter was supported by the then Cabinet Secretary for Health and Wellbeing, Alex Neil, before he moved over to his present portfolio.
When the charter was being developed, it was more to do with acknowledging the need for the intervention after a person has a stroke to be quick. That important rehabilitation needs to happen at the time and location that the person requires. Quick intervention could prevent the person’s stroke becoming that bit worse.
Margaret Mitchell gave us one or two stories, and those are the sorts of story that we have heard too often at the cross-party group. People can be wrongly assessed for a blue badge, for instance, because the full impact of their stroke is not recognised during their assessment. That is not the fault of the assessment process; it is a matter of not understanding the full impact that a stroke may have on an individual and on their ability to carry out tasks that they had undertaken before.
In my previous work at North East Sensory Services, I came across many people with a visual impairment as a result of stroke. The haemianopia that can occur is initially very difficult for patients, and certainly for their families and carers, but with the right support, understanding and instruction, a person can learn to live with that degree of sight loss as they understand it and are able to adjust to it. Too often, however, we do not get the right information or the right support at the time of need. That is frustrating not just for patients or sufferers—or survivors, as we say—but for their families and friends.
Margaret Mitchell is absolutely right. Stroke can have a devastating impact not just on a person’s mental health but on their ability to go back to employment, to do simple tasks or perhaps just to go out on their own and come back feeling refreshed from a walk. Quite often, the walk that they used to enjoy for leisure is now arduous and tiring; they might get to the point where they do not wish to do it any more.
The peer support that Chest Heart & Stroke Scotland provides is invaluable and immeasurable. Knowing that someone else has survived, has adjusted and has moved on is inspirational for many others. We need to be aware, however, that not just charities such as Chest Heart & Stroke but all of us have a responsibility, including general practitioners and clinicians.
Once again, I thank Margaret Mitchell for bringing the debate to the chamber. I sincerely hope that the Minister for Public Health is indeed listening.
17:19
I congratulate Margaret Mitchell on bringing this important debate to the chamber and I welcome, as she did, the young stroke survivors to Parliament today. Key to improving the quality of health and social care services is listening to the experiences of those who have had to use those services. Clearly, Margaret Mitchell has done that: she has drawn to the minister’s attention many important issues that need to be addressed.
When I read the motion, I felt that I wanted to emphasise the importance of the voluntary healthcare sector in general, and particularly—in the context of today’s motion—the work of Chest Heart & Stroke Scotland. Obviously, it works on all cardiovascular disease, but today we are concentrating on its stroke services. In looking for information, I found that it has 37 communication support services in south-east Scotland alone—I do not have direct knowledge of Lanarkshire—and that 1,333 people who have been affected by speech and language difficulties after a stroke have benefited from those services, which are the centrepiece of the motion. To be honest, I did not know the scale of support that is given to stroke survivors by Chest Heart & Stroke Scotland. We certainly should pay tribute to its work.
Of course, that is not the only area relating to stroke in which the organisation is active. Again in my area of south-east Scotland, it has seven stroke specialist services through stroke nurses, it runs a stroke training programme for professionals in Lothian and elsewhere and it has given research funding—for example, at the Western general hospital, the organisation supports a research project that aims to understand better the relationship between different blood pressure measurements and different types of stroke. Over and above that, the organisation has an advice and information line and it provides personal support grants to survivors of stroke.
The key thing that I want to do is pay tribute to Chest Heart & Stroke Scotland’s work. I know from looking at its strategy that it has plans over the next two or three years to involve service users even more than it does at present in planning and design of services, and to develop training for specialist staff.
Also, Chest Heart & Stroke Scotland has been involved in the think FAST—face, arms, speech, time—campaign, which is about the public recognising strokes. It has developed a campaign pack and disseminated it through the health service. Although general practitioner awareness, which Margaret Mitchell highlighted, is important, it is also important that the public can recognise the symptoms of stroke.
I want to talk about more positive developments that have taken place. Margaret Mitchell rightly highlighted all the actions that still need to be taken in relation to physiotherapy, speech and language therapy, social care and blue badges, which is certainly an issue that I have come across recently. However, we need to recognise that, in the years since the Parliament was established and, in fact, the three or four years before that, we have seen significant advances. For example, between 1995 and 2010, there was a 50 per cent reduction in premature mortality from stroke and, over the past 10 years, the number of new cases of cerebrovascular diseases has fallen by 21 per cent. “Stroke Improvement Plan”, which I read before the debate, tells us that in the most recent year for which we have figures there was a 10 per cent improvement in delivering key elements of the stroke care bundle. There are lots of issues about getting to a stroke unit and getting aspirin or thrombolysis, if that is appropriate.
We should recognise that there has been consistent progress over the years since the Parliament was created, especially in relation to hospital care for people who have had strokes. However, Margaret Mitchell is right to emphasise what happens after people leave hospital, and there are clearly many issues there that need to be addressed.
17:23
I, too, congratulate Margaret Mitchell on securing the debate and I welcome the young stroke survivors to the Parliament. It is a privilege to take part tonight, as I personally have benefited from heart surgery, back in 2006, in the middle of my successful 2006-07 election campaign. The repaired mitral valve and single bypass that I had done at that time are still fine, and my cardiologist in Inverness, the excellent Professor Steve Leslie, is very happy with me. I have a lot to thank the NHS for, including another major operation just 18 months ago on a bilateral subdural haematoma, which could have left me much worse off than I am. I have recovered extremely well, for which I am grateful. The NHS would not function so well without bodies such as Chest Heart & Stroke Scotland.
It is a great privilege to be vice convener of the cross-party group on heart disease and stroke, which does much good work under the convenership of Dennis Robertson.
Chest, heart and stroke conditions are wide and varied, which means that the information that Chest Heart & Stroke Scotland provides through its communication support services must be accurate and tailored to suit individual cases.
I have no doubt that we have all, in some way, been touched by the great work that Chest Heart & Stroke Scotland does—even if we have not been fully aware of the tireless work that its volunteers and employees undertake behind the scenes. Therefore, I thought that it would be useful to highlight some of the campaigns with which Chest Heart & Stroke Scotland is involved right now.
First, there is voices Scotland, which is a national network of people who are affected by chest, heart and stroke conditions and who want to have their say. Through free workshops and continuing support, people are provided with the knowledge, skills and confidence to work with the healthcare and social care services to help to plan new and better services.
Then we have the think FAST and save a life campaign, which has been mentioned already. It aims to raise awareness of stroke and acknowledges that, with more than 12,000 people in Scotland having a stroke every year, it is essential that folk recognise a stroke when it is occurring so that they are able to take prompt action.
In addition, there is the aphasia alliance campaign, which highlights the fact that a third of the estimated 12,500 people who have a stroke in Scotland every year will be left with aphasia—a condition that affects the language skills of sufferers after they have experienced brain damage. It can affect speech, understanding and reading and writing.
For people who have breathing problems, we have the COPD—chronic obstructive pulmonary disease—awareness campaign, which is important because there are more than 115,000 people in Scotland who have a diagnosed COPD. However, it is believed that many more people have a COPD but are unaware of it. Many folk relate symptoms of COPD to smoking or ageing and so tend not to report their symptoms to their doctors. Early diagnosis would hugely benefit those people.
Finally, there is the person-centred activities for people with respiratory, cardiac and stroke conditions—PARCS—project. It is a collaborative project that considers whether different physical activities in a variety of community settings meet people’s needs. All those campaigns involve hard-working health professionals, who are also supported by Chest Heart & Stroke Scotland and by many others who get involved.
E-learning resources are also available. There are links to several specific chest, heart and stroke-related web resources, along with national health and social care resources. That is helpful, because it enables people to see at a glance what resources are available in their areas.
For all that it does, I thank Chest Heart & Stroke Scotland and wish more power to its elbow. I have no doubt that without such bodies and charities our health service would crumble. I thank very much indeed all those who are involved.
17:28
I, too, thank Margaret Mitchell for lodging the motion and congratulate Chest Heart & Stroke Scotland on its contribution to stroke care in Scotland over the past 20 years. I also add my welcome to the young survivors group who are in the gallery.
Stroke remains the third-biggest killer in Scotland and the leading cause of disability, which is why it has been a clinical priority for NHS Scotland since the mid-1990s. Over the years, the stroke community, of which CHSS is a key stakeholder, has worked together to make excellent progress to deliver the best possible health and social care to people who have had a stroke. However, we will always strive to do more.
I am sorry to hear about the situations that Margaret Mitchell described of the people who have suffered strokes in North Lanarkshire. Those situations are not acceptable and I am glad that she has taken up the issues robustly with the chief executive of North Lanarkshire Council and will continue to do so. We should not put up with poor customer care and it must be challenged on every occasion. People have to learn that the best possible care and service should be given to those who need it.
I am glad that Margaret Mitchell mentioned adaptations. I was the convener of the Infrastructure and Capital Investment Committee, the remit of which included housing, and I know how important housing adaptations are in order that, for example, people can move from a hospital setting back to their homes as quickly as possible.
We have done a lot, and that is reflected in the updated stroke improvement plan that was published in August 2014, which sets out eight priority areas to ensure that we continue to strive towards improved prevention, treatment and care. All those with an interest, across all levels and roles, have an important part to play. It is by working together, learning together and sharing that we will deliver improvements.
We must also continue to strengthen ways to actively engage with people affected by stroke in order to learn from them and identify those issues that are important to them.
I am proud to say that we have supported Chest Heart & Stroke Scotland through collaborative working and that our relationship with the charity extends beyond stroke care, as we work collaboratively with it on improving care around heart disease and respiratory issues.
The CHSS community support service is a good example of partnership working between CHSS and the NHS. The service offers an important bridge for stroke patients between speech and language therapy and independent activities in the community. It provides stroke survivors, young and old, with an opportunity to increase their confidence and ability to communicate in a variety of social settings. Of course, the service that is provided to each individual is co-ordinated by someone who understands that person’s needs, and it can be delivered on a one-to-one basis or in peer support groups.
CHSS and NHS Lanarkshire also work in partnership to provide a number of other services, including stroke support nurses, training co-ordinators and financial advice. The services are there, but they are perhaps not being used in the best possible way, or are perhaps not known of. As Malcolm Chisholm said, not every situation is as Margaret Mitchell described.
Since 2010, CHSS has raised awareness of stroke symptoms with 11 successful FAST campaigns, which we support. More recently, in 2013, we provided CHSS with funding to coordinate a FAST campaign along with NHS boards, and it has developed a toolkit for boards to use locally. That funding also supported the production of a short online video featuring actors from the popular “Still Game” series to get the FAST message across. The FAST campaigns are aimed at the general public and healthcare professionals, including GPs. CHSS evaluations of the campaigns indicate that recognition of the FAST campaign message rose from 32 to 61 per cent, and that the proportion of patients or relatives who called NHS services for help within 30 minutes of the onset of symptoms rose from 46 to 62 per cent. That is really encouraging and shows that we must keep the campaign going so that it reaches even more people. I am glad that Dave Thompson highlighted the other campaigns that are run.
We recognise the importance of supporting stroke survivors to improve wellbeing and quality of life. That is why the stroke improvement plan sets out two priority areas that focus on rehabilitation and life after stroke. Those priorities take a person-centred approach and ensure that multidisciplinary stroke teams offer a range of self-management support. Stroke patients will have an acute therapy assessment and stroke rehabilitation delivered by a stroke specialist, based on the needs of the individual.
Personalised and integrated services for adults who have had a stroke will be strengthened further with the implementation of the Social Care (Self-directed Support) (Scotland) Act 2013 and the Public Bodies (Joint Working) (Scotland) Act 2014.
We are committed to working in partnership with the voluntary sector to support new ways of delivering services. We have the ideal opportunity to publicly acknowledge the good work that has been advanced in partnership with CHSS across a range of long-term conditions. We are keen to continue to work alongside charities such as Chest Heart & Stroke Scotland to make real improvements to the quality of life of people in Scotland.
Finally, I thank David Clark, who has been chief executive of CHSS since 1994 and a member of the Scottish Government’s national advisory committee for stroke since its inception more than 10 years ago. I wish him an enjoyable retirement when it comes in May.
Meeting closed at 17:35.Previous
Decision Time