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Chamber and committees

Meeting date: Tuesday, November 10, 2020

Meeting of the Parliament (Hybrid) 10 November 2020

Agenda: Time for Reflection, Topical Question Time, Covid-19, Remembrance Commemorations, Business Motion, Decision Time, World Stroke Day and Stroke Care (Covid-19)


Contents


World Stroke Day and Stroke Care (Covid-19)

The Deputy Presiding Officer (Christine Grahame)

The final item of business today is a members’ business debate on motion S5M-22992, in the name of Alexander Stewart, on world stroke day and stroke care in Scotland during the Covid-19 pandemic.

Motion debated,

That the Parliament recognises World Stroke Day, which is observed on 29 October each year to raise awareness of stroke and what can be done to tackle the condition; understands that stroke is a non-communicable disease that affects millions of people worldwide every year; believes that, although the COVID-19 pandemic has had a huge impact on everyone, the lives and recoveries of stroke survivors in Mid Scotland and Fife, and across Scotland, have been particularly badly affected; recognises what it sees as the disparity in the levels of stroke care between NHS boards in Scotland; acknowledges the publication of the Stroke Association report, Stroke recoveries at risk, which highlights how much stroke survivors’ lives and their recoveries have been affected, and notes the calls on the Scottish Government to make urgent progress on the stroke commitments that it made prior to the COVID-19 pandemic in its Programme for Government 2019-20, as well as on the establishment of a regular reporting mechanism to the Parliament on these commitments in order to track progress and ensure full transparency and accountability.

17:03  

Alexander Stewart (Mid Scotland and Fife) (Con)

I am delighted to take part in tonight’s members’ business debate, and I thank members who have signed and supported the motion.

First, I pay tribute to and acknowledge world stroke day itself. Observed on 29 October each year, world stroke day raises awareness of stroke and of the contribution made by individuals who have suffered, and it is in that spirit that I once again bring this simple message to Parliament.

Back in June 2017, I secured a members’ business debate on stroke care in Scotland. My speech at that time highlighted the sheer number of people in our country who experienced stroke annually and the efforts that were being made to look after and support those who survived. I highlighted the level of stroke care that existed in Scotland and the need for the provision of thrombectomy to improve. In my conclusions in that debate, I welcomed and acknowledged the work that had taken place to ensure that we had facilities to support victims and their families. The debate recognised the general optimism about ensuring that we had high-quality support for stroke nurses, with support systems and pathways in place to support individuals. We also noted the pragmatic approach of survivors towards recovery, wellbeing and aid in secondary prevention.

That previous debate took place nearly three and a half years ago but, since that time, despite all the good intentions that were echoed in the chamber by the then Minister for Public Health and Sport, not much has changed. Why is that? The same loyal constituents are still in touch with me, the same highly dedicated healthcare professionals contact me on a regular basis and I still work with the hard-working stroke charities across Scotland. The cross-party group on heart disease and stroke, which I co-convene, holds regular meetings.

I commend the stroke charities in Scotland—the Stroke Association and Chest Heart & Stroke Scotland—for their fantastic work and their contribution. I put on record my gratitude for the commitment of their fantastic staff. I mention, in particular, Colin Oliver of the Stroke Association and Katherine Byrne of Chest Heart & Stroke Scotland. They support the cross-party group, and they support individuals right across the country. Both charities have identified that stroke care in Scotland has been failing in key areas for some years, despite the best efforts of some truly extraordinary stroke specialists and staff across the country.

We know about the commitment to improve key areas, as announced by the Scottish Government back in September 2019. That work is welcome, especially given how stroke care has been massively impacted by Covid-19. We cannot blame Covid entirely, however, as many people call for. Back in 2017, promises were made and commitments were sought in the chamber, but, over the past three years, some of those commitments have not come to fruition.

I know that there have been major difficulties in supporting thrombectomy. As we have heard, many people have suffered—600 people across the country could have benefited from thrombectomy. The treatment is cost effective, and many people know about developments in that regard. I am delighted that there have been some reassurances recently at NHS Tayside, which has definitely helped with thrombectomy in that area, and things are beginning to move forward in other areas. I welcome that progress, although it has come too late for some people. Thrombectomy is cost effective, and we have all seen the quality of stroke care, as well as the awareness and understanding of what is happening. There is a postcode lottery, however, and we must recognise that. That simple action is not helping everybody, and more people may be becoming disabled because of a stroke. Every 10 minutes of delay in treatment, between arriving at a hospital and receiving clot-busting drugs, has been shown to take a month off a patient’s life.

“Scottish Stroke Improvement Programme: 2020 National Report” on the NHS Scotland stroke improvement programme has shown that key targets in the assessment of vital stroke care were still being missed significantly in 2019, well before the pandemic started. Furthermore, the latest stroke care audit figures, which were published in September 2020, show that a third of stroke patients do not receive even the most basic level of care, which is known as the stroke care bundle. Stroke care-bundle compliance is 64 per cent across Scotland. Admittedly, that is a small improvement on the figure of 59 per cent in 2018, but overall compliance still remains far below the 80 per cent standard that has been set.

Many health boards have not managed to challenge that and ensure that the standard is reached. There have been some improvements in NHS Dumfries and Galloway, NHS Tayside, NHS Ayrshire and Arran and NHS Highland, but we have seen no statistically significant change or improvement in the other health boards. That has to change, because compliance ensures that people have the opportunity to get the support that they need.

We know that someone who lives in Scotland is more likely to have a stroke at an earlier age than someone who lives in another part of the United Kingdom, and we know that more people die from strokes in Scotland than in other parts of the UK. During the pandemic, access to rehabilitation has been limited or has stopped altogether for many individuals, who feel that they have gone backwards.

We are well aware that all those areas are devolved to the Scottish Government, so it is vital that we work together and embrace the opportunity to change the quality of stroke support, to ensure that individuals get the access and the support mechanisms that they rightfully require.

In conclusion, I support and echo the Stroke Association’s principles, and I call on the Scottish Government to continue to make urgent progress with the stroke commitments in its programme for government; to establish a regular reporting mechanism for all stroke conditions; and to ensure that the Parliament receives regular updates. Only regular progress updates will ensure that stroke care does not become lost in the midst of the current pandemic.

17:10  

James Dornan (Glasgow Cathcart) (SNP)

I thank my colleague Alexander Stewart for bringing this incredibly important debate to the chamber, and I thank Chest Heart & Stroke Scotland for its helpful briefing and for all the good work that it does in keeping the dangers of stroke at the forefront of our thinking.

Stroke is a many-headed monster that attacks in so many different ways that it is almost impossible to prepare for. When it hits, it affects everyone differently. I will give three examples of how people have been affected by stroke and outline their different roads to recovery.

My partner Elaine had a stroke five years ago. You would never know it to look at her, except sometimes when she walks for too long, but she assures me that the long-term damage is still with her. She forgets things regularly and can be a bit unsteady at times, and we are still dealing with some of the other long-term issues. The good thing—if that is the right way to put it—is that she was young and fit enough to be able to get where she is today.

My mother had a stroke in February this year. She is older, and it is clear that recovery can be much more difficult for older people. In addition, we are living through Covid-19 and, despite the care and attention that my mother gets, she lacks some of the on-going physical and emotional support responses that may otherwise have helped her to recover more speedily.

The last example is a friend of mine named Paul. He had a stroke a month ago, with all the usual recognisable symptoms such as paralysis down the left side and slurring. Paul is a writer and blogger, and he is also left-handed—within the first week of his hospitalisation, he started typing slowly with his right hand. He did all the physiotherapy that was asked of him, and he told me just this afternoon that he expects to get home on Friday, which is good news.

In all three cases, the early impact was one of fear: that they would not walk or talk properly again, and that life as they knew it was over. However, as the examples show, that is not always the case. All strokes have a different impact and the pace of improvement is different. Nonetheless, in experiencing that fear, those three people all have something in common.

Sadly, their experiences are not unique. Countless families have had their world turned upside down. The effect of stroke can be life changing, whether for the person who experiences the stroke or for family and friends, who often undertake unpaid caring duties.

In Scotland, stroke remains a leading cause of disability and is the third biggest killer. In 2018, in more than 3,800 deaths in Scotland, cerebrovascular disease, including stroke, was the underlying cause. However, there is some cause for tentative optimism. Over the past 10 years, the number of people dying from stroke in Scotland has decreased by more than 35 per cent. According to the Stroke Association, there are almost 120,000 stroke survivors living in Scotland. As I have described, however, surviving stroke is one thing, but being able to live with the resulting health implications is another. All survivors deserve the best possible chance of living without disability or dependence after stroke.

That is why I welcome the Scottish Government’s commitment, in its programme for government, to

“Introduce a high quality and clinically safe thrombectomy service in Scotland”.

As Alexander Stewart said, thrombectomy delivers significant benefits for some patients who experience sudden onset of stroke, with significantly improved outcomes and a reduced level of disability. The new service, once it is established, will ensure that those who experience severe stroke receive the best possible care, thereby reducing their risk of long-term disability. Figures cited by Chest Heart & Stroke Scotland show that at least 600 people in Scotland per year would benefit from a thrombectomy. I am delighted that the Queen Elizabeth university hospital campus in Glasgow will provide a hub service for the west of Scotland by 2023.

Someone has a stroke every five minutes in the UK—it can happen to anyone of any age at any time. All members who are participating in the debate will share a desire to reduce further the number of deaths from stroke and improve treatment and care. At a time when Covid is understandably grabbing most of our attention, it is vital that we keep stroke on the agenda, and I thank Alexander Stewart again for affording us the opportunity to do so today.

17:15  

Brian Whittle (South Scotland) (Con)

I thank my colleague Alexander Stewart for bringing this important debate to the chamber.

I have spoken about the subject before, but this year it is even more important given the extraordinary situation in which we find ourselves. Prior to the Covid pandemic, stroke care had been falling generally in Scotland. The Scottish Government made a commitment in 2019 to address that trend. Covid has exacerbated the issue.

The recent “Stroke recoveries at risk” report tells us about the impact of Covid-19 on stroke survivors and their carers in Scotland. More than half say that they have received less support from health and care services than usual. More than half reported that their therapy had been cancelled or postponed, and two thirds reported feeling more anxious or depressed. Of course, that is a general theme throughout the country, although those concerns are exacerbated by conditions such as having had a stroke.

As members know, I speak a lot in the Parliament about the preventive health agenda, and stroke fits into that well. Scotland has a poor health report card and the impact of Covid on ill health highlights that. A person is more likely to have a poor result from Covid if they suffer from a condition such as having had a stroke. It is important that we tackle that.

As Alexander Stewart said, in Scotland a person is more likely to have a stroke than in any other part of the United Kingdom, they are more likely to have a stroke at a younger age—Scotland’s average age is four years below that of the rest of the UK—they are more likely to die from a stroke, and Scotland has the largest percentage of population who are stroke survivors. We know the scale of the situation in which we find ourselves.

There are, however, some good practices out there that I will highlight. I have spoken before about the stroke physiotherapists in Kilmarnock, who have, with the help of a grant, taken it upon themselves to look at extending the care for stroke survivors beyond the six weeks that they get in hospital. They have taken that rehabilitation into the community and, as well as looking after stroke survivors, they treat a lot of other comorbidities. The group has highlighted to me that there are positive outcomes after strokes.

Prior to the stroke physiotherapists taking their service into the community, they told me that a lot of stroke victims sit at home feeling scared and worried about having another stroke. However, taking the service into the community through the cunning use of a cup of tea and a biscuit, which stroke patients can get to if they do a little bit of physical exercise, helps them to get back into the community and into the mainstream. For some, it can help them to get back to work. That is exactly what we want.

As I said, and as has been well rehearsed in the chamber, Covid has highlighted a major issue regarding the number of conditions that have been impacted by the restrictions that have been put in place. I was contacted by a constituent who said that they feel

“Let down by the system. There was no support at all for stroke survivors in the area. Everyone is having a challenging time just now, but the lives and recoveries of stroke survivors across Scotland have been particularly badly affected. We need you to stand up for us.”

Their call to the Scottish Government is to make urgent progress on the stroke commitments that were made prior to the pandemic and to regularly report to the Parliament so that we all know what is going on. It is vital that people who have been affected by stroke are not forgotten due to the Covid-19 pandemic. That is why I once again thank Alexander Stewart for bringing this important debate to the chamber and enabling us to highlight current issues.

17:19  

David Stewart (Highlands and Islands) (Lab)

I too thank Alexander Stewart for securing this evening’s important debate and for the quality of his speech. It is crucial that we pay attention to the care of victims of strokes and that we be clear on the symptoms if we are to prevent some of the life-changing ordeals that individuals endure.

The excellent briefing provided by Chest, Heart & Stroke Scotland raised the issue that improvements to stroke care have stalled since Covid-19 arrived in the country, and that will be the sad story across many areas of health. Problems with access to support and rehabilitation because of delays to non-urgent and outpatient appointments have led stroke survivors to report that their recovery has not only stalled, but gone backwards.

The strong campaign on the alert message of FAST—face, arms, speech and time—has been a positive way to make communities aware of the signs of a stroke, and I hope that it has meant that more victims have been able to get help in time. It is now more critical than ever that we spread the message, as evidence suggests that Covid-19 increases the risk of blood clots and strokes.

As previous speakers have said, strokes are the third most common cause of death in Scotland and the most common cause of disability. That is why it is so important that we help to make more people aware of how to help, and also that we call for increased support, both through the national health service and through the important work that is being done by the third sector.

Again as we have heard from previous speakers, the chances of having a stroke are sadly higher in Scotland than in other parts of the United Kingdom. Strokes are also more likely in younger people, as the average age for having a stroke in Scotland is four years below that in the rest of the UK. People are more likely to die from a stroke in Scotland than in the rest of the UK, and Scotland has the largest percentage of population who are stroke survivors. Those are some pretty sobering facts.

It is estimated that the number of stroke survivors in Scotland will increase by a whopping 50 per cent over the next 20 years. It is vital that we put in the resources now to ensure that the NHS is able to support victims and families in the years to come.

We have also heard about the importance of thrombectomies, which are an innovative surgical technique that removes blood clots from arteries and veins. Some pioneering work has been done on that in NHS Tayside. Thrombectomy is not currently a national service but, as we have heard from previous speakers, it has been suggested that it will be rolled out to other parts of Scotland; that is crucial.

Alexander Stewart made a very important point when he mentioned the stroke care bundle. Its aims include reducing the risk of death from stroke; increasing the likelihood of people returning home to recover; quick admission to a stroke unit; and fast access to vital interventions such as brain scans, swallow screens and the administration of aspirin. The bundle was set a compliance target of 80 per cent across NHS health boards. Although compliance went from 59 per cent in 2018 to 64 per cent in 2019, it still fell significantly short of that target. It should be noted, however that four health boards improved their compliance, including my board, which is NHS Highland.

A joined-up approach by the NHS, social care services and charities is needed, to ease pressures on stroke services and staff so that the quality of stroke care can improve and so that community-based holistic support can be provided.

I thank the dedicated NHS staff who are working flat out in these trying and complicated times. I thank the charities and third sector organisations that dedicate their time to supporting this work, and I thank social care providers and community pharmacists and physiotherapists, who are all part of it. I thank the families and the thousands of unpaid carers who are giving their time, energy and love to those who need it through the trauma and the often lasting effects of strokes. Finally, I thank Alexander Stewart for taking the initiative to secure tonight’s debate.

17:23  

Beatrice Wishart (Shetland Islands) (LD)

I, too, thank Alexander Stewart for securing this important debate and for raising the importance of strokes and world stroke day. I am pleased to support the motion.

Strokes have not stopped because of Covid, so we must ensure that stroke survivors have equity in stroke care during and after the pandemic. Each year in Scotland, 10,000 people have strokes. For survivors, the impacts can include speech and communication problems and physical disability. It can be devastating and, as others have said, the impact is not just on survivors, but on their carers, families and friends.

In Shetland, around 40 people a year have a stroke. In the past 15 years, the figure has come down from 55 a year Two thirds of patients survive their stroke. Lifestyle changes and improved treatments have made an impact on the figures, as has the work of dedicated healthcare professionals across the country. I am thinking of professionals such as Dorothy Storey, who is a recently retired specialist stroke nurse. I pay tribute to Dorothy, whose dedication to the care of stroke survivors is well known in Shetland. She has also played an active part in Shetland Stroke Support Group. I wish her well in her retirement.

I recently met members of the Shetland Stroke Support Group—it was a virtual meeting, of course. They are a fantastic group of people who, under normal circumstances, have a busy schedule of get-togethers and outings to various parts of Shetland. They have missed those visits this year and are, like everyone else, having to adapt to the new normal. They have a strong networking bond and provide one another with much-needed support.

Such support is especially needed in island and rural areas, where it is not always easy to access treatment and support services. Services are centralised in Lerwick, so for a stroke survivor from the north isles of Shetland there can be a tiring journey to hospital—for example, for a physiotherapy session.

I have personal experience of the impact of stroke on a family. My mother was living in Aberdeen at the time of her stroke in 2004. I rushed to Aberdeen on the first flight that I could get from Shetland, but by the time I saw her in the accident and emergency department she had lost power down one side of her body and her speech was obviously affected. I am firmly of the belief that by the time the consultant came—eventually—to discuss her prognosis, the idea of her receiving any treatment had been dismissed, simply because of her age. She was 81. Even if she could have benefited from a thrombectomy, she would not have received one. “She’s had a long life”, said the consultant. That was true, but he did not know her spirit; he knew only her date of birth. She returned to Shetland to live in a care home, but the effects of the stroke caught up with her, and she spent a prolonged period in hospital until her death, aged 87. She was cared for by a wonderful dedicated team in the Ronas ward.

I use that experience to illustrate how far stroke treatment and care have come in the past 15 years. However, as the Stroke Association highlighted in its briefing for members, there is wide variation in the performance of NHS boards, and a patient’s outcome is dependent on where and when they have a stroke. I add my voice to the association’s call for a national thrombectomy service that works, and for improvement in door-to-needle times. Please let us end the postcode lottery of stroke care in Scotland.

17:27  

Kenneth Gibson (Cunninghame North) (SNP)

I congratulate Alexander Stewart on securing valuable debating time on a matter that affects so many of us.

A stroke can happen to anyone, anywhere and at any time. Stroke is the most common cause of disability and the second most common cause of death worldwide. According to the World Stroke Organization, globally 14.5 million people have a stroke each year and, sadly, 5.5 million people die as a result, although research shows that almost all strokes can be prevented.

Here in Scotland, about 15,000 people have a stroke each year and hospital care for stroke patients accounts for 7 per cent of all NHS beds and 5 per cent of our NHS budget.

Despite the frequent occurrence of strokes, many people are unaware of the numerous and often life-changing challenges that are faced by patients who survive a stroke, which include communication difficulties, physical disability, changes in how they think and feel, and loss of employment, income and social contacts. It is fortunate that research has proved the effectiveness of organised specialist stroke care in improving outcomes.

However, in its report, “Stroke recoveries at risk”, the Stroke Association reported that almost all aspects of stroke treatment and care have been impacted by the Covid-19 pandemic. The pandemic is affecting the lives of stroke survivors and their families across all stages of their recovery, and in all countries of the United Kingdom. The association found that because of the Covid-induced severe pressure on the national health service, more than half of all stroke survivors in Scotland had had their therapy cancelled or postponed during lockdown. Other survivors’ stroke-related appointments were conducted over the phone or online to protect them from contracting Covid-19.

It is encouraging that people reported being reasonably satisfied with their virtual or phone appointments, although people felt that there was room for improvement. Some 58 per cent of stroke survivors in Scotland were satisfied with virtual methods of rehab and healthcare, compared with the UK average of 52 per cent. That underlines the innovation and dedication of our fantastic NHS workers, even in the most challenging of times. I also welcome the report’s finding that, compared with the UK average, a high percentage of stroke survivors in Scotland felt that they had been given enough information about how lockdown guidance applied to them.

However, stroke survivors’ mental health has, unfortunately, worsened significantly in Scotland and across the UK. Many survivors have reported feeling more stressed and depressed during lockdown, and carers are also feeling additional pressures. I therefore agree with the report’s conclusion that

“Now is the time to deliver stroke improvements, from prevention through to long-term support.”

It is encouraging that the Scottish Government continues to implement what is in “Stroke Improvement Plan”, which reaffirmed stroke as a clinical priority for NHS Scotland. In the past decade, the number of people in Scotland who have died from stroke has decreased by a heartening 42 per cent. Although that progress makes me optimistic, we must continue to improve care and outcomes.

I therefore welcome the fact that, after the delay that has been induced by the coronavirus pandemic, a pilot thrombectomy service is due to launch at Ninewells hospital in Dundee. I also welcome the Cabinet Secretary for Health and Sport’s announcement that similar services will be available in Edinburgh and Glasgow in 2021 and 2022 respectively. It must be our goal to have thrombectomy available for everyone who needs it by 2023. For that to be workable, a strong supporting framework also needs to be in place for all stroke patients before and after their stroke.

It is promising that the latest Scottish stroke care audit report showed a 5 per cent increase in stroke care-bundle compliance. That means that a growing number of hospitals and units now meet the standards of basic care that every stroke patient should receive when they arrive in hospital, including access to swallow testing, aspirin and brain scan.

However, the remaining variations in how stroke units and health boards meet those standards must now be addressed, as the Scottish Government continues to progress its ambitious 2019-2020 programme for government commitments.

I am confident that we will not only carry on reducing the number of deaths from stroke, but that we will make a positive difference to the lives of survivors and their carers, while easing the growing burden of stroke on our health and care system in the years ahead. I thank Alexander Stewart for bringing the debate to Parliament.

17:31  

The Minister for Public Health, Sport and Wellbeing (Joe FitzPatrick)

I am delighted to respond to the debate on behalf of the Government. I thank Alexander Stewart for lodging the motion to secure the debate and members of all parties for their speeches.

Mr Stewart is absolutely right about the importance of raising awareness of stroke and I join him in his acknowledgement of world stroke day. I also wish to acknowledge the important findings of the “Stroke recoveries at risk” report published by the Stroke Association, which has been mentioned by several members. I fully agree that stroke has a significant impact on people across Scotland and that the Covid-19 pandemic has exacerbated that impact.

Stroke is the third most common cause of death in Scotland and the most common cause of severe physical disability among adults. The condition has a significant impact on NHS resources, accounting for approximately 5 per cent of total NHS costs. It has an even higher societal cost. The personal impact on people who experience a stroke and on their family members and friends is massive, as James Dornan and Beatrice Wishart outlined.

The Scottish Government is committed to ensuring that people who have had a stroke receive the best possible care, as quickly as possible, to enable them to live longer, healthier, and independent lives. To achieve that, we continue to implement our stroke improvement plan, which sets out our priorities for improving diagnosis, treatment and care for stroke. We also continue to support the Scottish stroke improvement programme. That enables us to ensure that NHS boards appropriately plan and deliver the high-quality, safe and effective stroke services that people in Scotland expect and deserve.

Significant progress has been made. As James Dornan said, the mortality rate for stroke has decreased by 35.2 per cent in the past 10 years and the number of new cases of cerebrovascular disease, which includes stroke, has fallen by 12 per cent over the same period. That shows that our plan for tackling stroke is delivering real improvements. However, we want to continue to make progress on that and we will do so.

David Stewart outlined the medical benefits of thrombectomy. As Alexander Stewart and others noted, the first step towards a national thrombectomy service for stroke patients was taken yesterday with the launch of a pilot for the north of Scotland in NHS Tayside. Kenneth Gibson outlined how that would be rolled out for the rest of Scotland. It is important that that life-saving procedure is available across Scotland.

I am also pleased to let the Parliament know that Professor Martin Dennis has been appointed as the chief medical officer’s speciality adviser for stroke care and that Dr Fiona Wright has been appointed as deputy speciality adviser for stroke. Both advisers are tasked with progressing the programme for government commitments to which members have referred.

Work is under way to review the current stroke care bundle and to scope out what a progressive stroke unit will look like. We are working closely with our third sector partners, Chest, Heart and Stroke Scotland, and the Stroke Association, across all our commitments on stroke. We are particularly grateful for their work with us to ensure that people with lived experience of stroke are closely involved as we make progress against those commitments.

Mr Stewart, Mr Dornan and others mentioned Covid-19. We are all too aware of the impact that the Covid-19 pandemic has had on all our lives. Some have faced the personal experience of ill health, some have lost a loved one and everyone has had to deal with the impact of restrictions and adapting to a very different way of life. Brian Whittle and Kenneth Gibson mentioned the “Stroke recoveries at risk” report, which details how the pandemic has affected every aspect of stroke treatment and care and has had a significant impact on people living with stroke.

The recent publication of the Public Health Scotland report on the underlying causes of excess deaths in Scotland during the Covid-19 pandemic by area deprivation, clearly shows us the impact that Covid has had on those living with underlying health conditions. I recognise that Mr Whittle has a particular interest in that area. It is important for us to fully understand the situation. That is why we are working with Public Health Scotland and National Records of Scotland on a programme of research to understand the wider impact of Covid-19 on Scotland’s population.

Kenneth Gibson mentioned the “Stroke recoveries at risk” report’s recommendations on access to mental health provision and support for carers. Those are important areas and the pandemic has had an impact on people’s mental health and wellbeing. That impact is likely heightened for people who are living with, or caring for someone with, a long-term health condition, such as stroke. To respond to those challenges, the Scottish Government has worked with organisations from across Scotland to create a new online hub that provides a range of resources to help carers look after their physical and mental health. I encourage anyone concerned to look at that and the range of other support that is available.

I would like to conclude by acknowledging again that, despite progress over the past decade, stroke continues to have a significant impact on people in Scotland. Further to that, it is clear that the Covid-19 pandemic has created pressure on healthcare services and affected service delivery in a variety of ways.?That has undoubtedly had an impact on people living with stroke and on the services that provide diagnosis, treatment and care to those people.

The Scottish Government continues to learn from our experiences throughout the pandemic. Kenneth Gibson outlined some of the innovations that have been brought about because of the pandemic. Some of those may continue after the pandemic to improve people’s experience, although perhaps they will be a bit less virtual and a bit more blended. However, the experience has been positive. We continue to support healthcare services to build on the new and innovative ways in which they have responded to the challenges during this time to remobilise services, which we hope will minimise future delays.

Alongside that, through our programme for government commitments, we continue to drive improvement in diagnosis, care, treatment and support for people with stroke, taking into account the legacy of Covid-19. By combining our efforts and working with partners, we can make a real difference to those living with stroke in Scotland. I look forward to continuing those constructive and productive discussions and to continuing our improvement of stroke outcomes in Scotland.

Meeting closed at 17:38.