Chamber and committees

In response to the pressures on NHS services caused by the pandemic over the past 18 months, the First Minster launched the NHS Recovery Plan, on the 25 August. The Plan sets out the Scottish Governments key headline ambitions and actions to be developed and delivered now and over the next 5 years.

While it is important to stress that recovery is the immediate task, this Plan is fundamentally about ensuring that the process of recovery focusses on alternatives pathways of care that allow people to be treated more quickly closer to home and also delivers long term sustainability. The plan is backed by more than £1 billion of investment over the next five years.

The core criteria for defining a stroke unit are well described in the academic literature, including in Langhorne et al (2002). Though the size and configuration of stroke units across Scotland may vary depending on local factors, most will be in a defined ward setting and have a specialist stroke multidisciplinary team.

Covid-19 has had an unprecedented impact on the world, NHS Scotland and stroke services. Each service will have responded in the best way that it could, depending on the specific issues affecting them.

The 2021 Scottish Stroke Improvement Programme Report (which includes 9 months of the pandemic) shows slight deterioration in performance against the stroke standards for stroke unit access (77% in 2020 compared to 82% in 2019).

While stroke unit access declined, achievement of standards in other areas, including brain imaging within 12 hours of arrival (86% in 2020 compared 84% in 2019), time to carotid intervention (61%; 59%) and mean thrombolysis door-to-needle (DTN) time (51 minutes in 2020 compared to 53 minutes in 2019), improved.

All of these aspects also have an important impact on recovery from stroke, and therefore it is not possible to isolate the recovery impact based on one standard (such as stroke unit access).

Work is ongoing to produce a progressive stroke pathway document by December 2021. This will take account of international evidence, including the World Stroke Organisation’s roadmap to delivering quality stroke care, to define what a progressive stroke pathway should look like in Scotland.

The progressive stroke pathway will, similarly to the roadmap, follow the continuum of care starting at the onset of a stroke event through the acute phase (emergency department and inpatient care), and stroke rehabilitation and long term supported recovery.

Following this, an implementation plan will identify any gaps between current capacity and the progressive stroke pathway vision, and outline clear actions to take.

ScotGEM students are very specifically entitled to apply for a £4,000 per year ‘return of service’ bursary. This means for every year they take this they are committing to stay and work in NHS Scotland for a corresponding amount of years. Once the first cohort of ScotGEM students graduate in Summer 2022, we intend to evaluate the effectiveness of the ScotGEM bursary in retaining trainee doctors in hard to fill posts within our healthcare service. Further consideration to any extension can be made at that point.

We continue to work with key partners across Scotland to ensure that relevant information from patient health records is available to healthcare staff when and where they need it. Significant investment in national IT systems, such as those for GP practices and the TrakCare hospital patient management system in secondary care, has improved the flow of information across different healthcare settings and services. In addition, the availability of Regional Clinical Portals, the roll out of HEPMA ( Hospital Electronic Prescribing and Medicines Administration ) and availability of the patient Emergency Care Summary (ECS) to Community Pharmacists, Dentists and Optometrists have all improved the accessibility and quality of electronic patient information available to frontline staff.

Further improvements will be made including the implementation of Office365 across the entire NHS. This will include the rollout of single identities for NHS staff which will simplify secure access to relevant patient information. The refreshed Digital Health & Care Strategy, scheduled to be published in September 2021, will set out ambitions for greater access to medical information both for staff and the public.

Information on the location of vaccinations, cross referenced with the recipients health board, is not held centrally.

There is evidence that achieving the stroke bundle reduces mortality and increases the chance of patients returning to their usual place of residence after stroke.

There are a number of other factors in achieving an acceptable level of care for people with stroke. However, the stroke bundle is a simple metric which has been shown to be associated with improved outcomes. The Scottish Stroke Improvement Programme Team will continue to support NHS Boards to achieve the Stroke Bundle as well as supporting improvements across the stroke pathway.

The Scottish Government supports the planting of the right tree in the right place. Forest and woodland strategies, including the Scottish Borders Woodland Strategy , set the regional framework for woodland expansion and are developed by the local authority in partnership with interested stakeholders. These strategies identify preferred areas where forestry can have a positive impact on the environment, landscape, economy and local people, and also identify sensitive areas where forestry may not be a suitable choice.

The Regional Strategic Woodland Creation Project is furthest developed in the South of Scotland. Here it is being developed as an evolution of the Scottish Borders Woodland Strategy . The ambition is to better define where the preferred areas for woodlands are, helping bridge the gap between strategic and site level considerations.

Regional Land Use Partnership (RLUP) pilots are being established this year, with Regional Land Use Frameworks (RLUF) being developed by 2023. The RLUPs will work within the existing context of their region, including identifying and working with key strategies and projects. The South of Scotland is one of the pilot regions. They are now beginning to engage with stakeholders on their regional approach, which will include engagement with forestry stakeholders as well as local communities, land managers and owners, experts and local and national government.

The Scottish Government is grateful to everyone who has volunteered for COVID-19 vaccine trials in Scotland. The clinical trials participants have made an important contribution in tackling the coronavirus pandemic.

The digital application to record the COVID-19 vaccine will be available from 30th September. Clinical trial participants who have received a licenced product and are un-blinded will be able to access the application.

Other clinical trial participants will not have access to the application at this time. However, other measures are in place to provide proof of vaccination. This includes a letter of support and subsequently participants will receive a hard copy Record of Vaccination which contains security features and 1-D barcode.

This Record of Vaccination can be used across the UK. In due course, this will be replaced by a QR Record of Vaccination with a QR code.

The Scottish Government are committed to ensuring that these participants are not disadvantaged. Work is ongoing to ensure that vaccine status is correctly presented on the coronavirus vaccine database.

All those individuals who have participated in coronavirus vaccine clinical trials in Scotland, should have already received a letter from their Chief Investigator confirming their involvement. The letter allows them to attend events or access services throughout the UK in the same way as those who are fully vaccinated.

You may find more information on clinical trials on NHS inform: Coronavirus (COVID-19) vaccination status for clinical trial participants | The coronavirus (COVID-19) vaccine (nhsinform.scot)

There is no data held on reasons for missed or non attendance for COVID-19 vaccine appointments.

In the statistical report for 16th of June 2021, Public health Scotland published a one-off analysis of "did not attend" (DNA ) appointments for the time period between 1 February 2021 and 6 June 2021. In this they found that 18.2% of first dose appointments and 3.9% of second dose appointments had resulted in either a missed appointment or a cancellation. The full report is available here : COVID-19 Statistical Report - 16 June 2021 - COVID-19 statistical report - Publications - Public Health Scotland