Chamber and committees

This process is currently underway. Health Boards have been asked to submit 22-23 plans linked to activity trajectories and requests for funding, which will be used to allocate resources to address orthopaedic surgery waiting lists.

Additionally, as part of our 100 days commitments, we published an NHS Recovery Plan in August 2021. This sets out our plans for health and social are over the next 5 years. Backed by over £1 billion of funding, the Plan will support an increase in inpatient, daycase, and outpatient activity to address the backlogs of care in orthopaedics and other areas, supported by the implementation of sustainable improvements and new models of care.

The numbers of confirmed strokes admitted during 2016 - 2021 showing median time (minutes) to brain imaging are shown in the following table:

The Scottish Government welcomes the work of the European Stroke Organisation and agree that it is vital to ensure improvements are made to stroke pathways and services, including prevention, treatment and care.

Through our Programme for Government commitments and the Stroke Improvement Plan, we are already reflecting the aims of the European Stroke Organisation’s appeal targets.

We are supporting the National Advisory Committee on Stroke to develop a progressive stroke pathway document which will set out the vision of what stroke services across Scotland should deliver across the whole patient pathway, including access to stroke rehabilitation, and access to support for people who have experienced a stroke. However, at this time, the Scottish Government does not have plans to use the tracker. The Scottish Stroke Care Audit will continue to track our progress against the Scottish stroke care standards.

The Scottish Stroke Improvement Team have reported on a 12 hour Standard for brain imaging since the Scottish Stroke Improvement Programme National Report (2020). Prior to this, the standard had been within 24 hours. This change in Stroke Standard was in response to a change in the evidence base, with some new treatment regimes being shown to improve outcome when initiated within 12 hours of stroke onset.

Some cases of stroke are time critical emergencies and should be scanned immediately, for instance those patients requiring hyperacute interventions such as thrombolysis and thrombectomy. These specific cases have their own stroke standards on door-to-needle times which ensure that processes are audited and service improvement packages are put in place.

Planning of community rehabilitation delivery is the responsibility of individual NHS Boards and Health and Social Care Partnerships.

Our vision is for everyone with rehabilitation needs to be able to access the care and support they need to live well, on their own terms. Exploring ways to improve access to rehabilitation is a key aspect of the work underway to develop a progressive stroke pathway document.

With regard to measuring performance, the provision of appropriate rehabilitation, in both acute and community settings, currently forms part of the Scottish Stroke Improvement Programme (SSIP) criteria-based assessments.

These are currently being reviewed and expanded and will form part of the regular reviews which are undertaken by the Scottish Stroke Improvement Programme team with each Health and Social Care Partnership. We will also consider how these might be integrated into the Scottish Stroke Care Audit if effective.

I refer the member to the answer to question S6W-05487 on 21 January 2022. All answers to written Parliamentary Questions are available on the Parliament's website, the search facility for which can be found at https://www.parliament.scot/chamber-and-committees/written-questions-and-answers

There is evidence that access to a stroke unit improves outcome for stroke patients.

The Scottish Stroke Care Audit (SSCA) monitors the quality of care provided by the hospitals in all NHS Boards and access to a stroke unit is a standard measured by SSCA, alongside other standards associated with improved patient outcomes. Performance against the standards, and more detail on service models can be found here:

Scottish stroke improvement programme 2021 national report - Scottish stroke improvement programme - Publications - Public Health Scotland .

There are a wide range of definitions for Stroke Units and it is understandable that stroke units will look very different between, for instance, a large city hospital and island NHS Boards

The core criteria for defining a stroke unit are well described in the academic literature, including in Langhorne et al (2002). Professor Langhorne is a member of the Scottish Stroke Care Audit (SSCA) Team and has been influential in defining different models of stroke unit care.

NHS Boards are expected to describe their stroke unit models through the SSCA processes and the Scottish Stroke Improvement Programme Team review this information during Board Reviews (now occurring at least twice annually). This ensures that optimal and evidence based services are being delivered and demonstrates that stroke units are viewed as a core component of care.

The number of confirmed strokes discharged during 2021 showing total length of stay and length of stay in a stroke unit is in the following table.

For some of the figures, the length of stay in the stroke unit are longer compared to stay in the audit. The patient may have completed the stroke part of their journey, but they did not have a discharge plan, so would be discharged from the audit. However, they are still in the stroke unit, for example if they have another condition that is more important than stroke.

We are supporting the National Advisory Committee on Stroke to develop a progressive stroke pathway document which will set out the vision for what stroke services across Scotland should deliver across the whole patient pathway, including access to stroke rehabilitation, and access to support for people who have experienced a stroke.

Scottish Government will work closely with the Stroke Improvement Programme Team and stakeholders throughout 2022 to develop an implementation plan to deliver the vision set out in this document.

We will continue to take steps to introduce a high quality and clinically safe thrombectomy service in Scotland. A Scotland wide service is expected to be operational by 2023.