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Chamber and committees

Meeting date: Wednesday, June 21, 2017

Meeting of the Parliament 21 June 2017

Agenda: Motor Neurone Disease Global Awareness Day, Business Motion, Portfolio Question Time, Freedom of Information Requests, Agriculture, Business Motion, Parliamentary Bureau Motions, Prohibited Procedures on Protected Animals (Exemptions) (Scotland) Amendment Regulations 2017 [Draft], Point of Order, Decision Time, Stroke Care


Stroke Care

The Deputy Presiding Officer (Linda Fabiani)

The next item of business is a members’ business debate on motion S5M-05474, in the name of Alexander Stewart, on stroke care in Scotland. The debate will be concluded without any questions being put.

Motion debated,

That the Parliament understands that, every year,14,000 people in Scotland experience stroke, which is the third most common cause of death and the most common cause of severe physical disability among adults; believes that stroke patients account for 7% of all NHS beds and that treatment for the condition takes up 5% of the NHS budget; considers that there is well-established evidence demonstrating the benefits of organised specialist care in improving outcomes; notes the recent SIGN guidelines that focus on acute care and secondary prevention and emphasise the importance of providing access to specialist services quickly; understands that there has been a welcome long-term downward trend in mortality rates, with a 39% decrease between 2006 and 2016; considers that the challenge now is that more people than ever, around 124,000, are living with the long-term effects of stroke, half of whom have a disability; notes that, in the most deprived areas, the mortality rate in 2015 for such cerebrovascular diseases was 42.3% higher than the least deprived; recognises that people in remote and rural areas can face issues in accessing clinical care, including access to thrombectomy, which is unavailable outside Edinburgh and Glasgow as there are only three clinicians trained to carry out this procedure in Scotland, compared with over 80 in England and Wales; notes the view that greater investment would help tackle what it sees as this inequity; believes that, outside the work of the recognised charities, only NHS Greater Glasgow and Clyde and NHS Tayside offer specialist follow-up nursing, but with more limited scope and timescales; understands that stroke nurses provide flexible and holistic support that covers health, wellbeing, socialisation, vocational rehabilitation and advice on financial issues, and notes the opinion that there is an urgent need for further investment in high quality aftercare, more stroke nurses and support systems and pathways in place in communities in Mid Scotland and Fife and across the country to keep survivors active in order to improve recovery, wellbeing and to aid secondary prevention.


Alexander Stewart (Mid Scotland and Fife) (Con)

I am grateful for the opportunity to open this members’ business debate on stroke care in Scotland, and delighted to take part.

Every year, 14,000 people in Scotland experience stroke, which is the third most common cause of death and the most common cause of severe physical disability among adults. Stroke patients account for 7 per cent of national health service beds and treatments for the condition, which takes up around 5 per cent of the NHS budget.

It may be appropriate at this stage to describe, in layman’s terms, a bit about stroke and why the diagnosis and treatment is so multifaceted. In Scotland, sadly we know and understand “heart attack”; stroke is quite literally a “brain attack”. It happens when the blood supply to part of the brain is cut off. As we all know, blood carries essential nutrients and oxygen to the brain; without that, the brain can be damaged and cells can die. That damage can have different effects depending on where it happens in the brain. A stroke can also affect the way in which someone’s body works, as well as how they think, feel and communicate.

Most strokes are caused by a blockage cutting off blood supply to the brain, but they can also be caused by bleeding in and around the brain. It is also possible to suffer a mini-stroke, which is the same as a stroke, except that the symptoms last a short time—normally no longer than 24 hours. That is because the blockage that stops the blood getting to the brain is only temporary.

As we age, our arteries become harder and narrower and are more likely to become blocked. However, certain medical conditions and lifestyle factors can speed up the process, as has been well documented.

People have often asked me whether it is possible to recover from a stroke. For some people, the effects may be relatively minor and may not last long, although others may be left with more serious problems that make them dependent on other people. Unfortunately, not everyone survives. Around one in eight people die within 30 days of having a stroke. That is why it is important to be able to recognise the symptoms and get medical help as quickly as possible. If that is done, the individual stands a much better chance. It has to be noted that stroke diagnosis, resulting in prompt action, and immediate care in Scotland are amongst the best in the world. However, I want to spend time this evening talking about post-stroke aftercare and assistance in recovery.

Just under a year ago, not long after I became a member of the Scottish Parliament, one of my constituents contacted me and told me a story about his wife’s issues with stroke. He wrote:

“Lynda had a stroke in March 2003. She was 44 years old, a mother then of 10-year-old twin girls, and a primary school teacher in Dunblane. It was totally unexpected. She was having a cello lesson at home.

At the start of the cello lesson she was fine, as she finished her lesson there was obviously something dramatically wrong. By the time Lynda arrived at A&E she was almost in a coma, and stayed in a coma for a few days. She was cared for in intensive care. She was later transferred to a high dependency unit for around a week—where her care was arguably very good—although not specialised in stroke.

After that, she was transferred to what was deemed to be a ‘stroke unit’.”

My constituent learned directly from the consultant that there were no trained stroke nurses in Lynda’s ward, which was predominantly or exclusively geriatric.

Lynda was in hospital for 10 weeks. At the start of her recovery phase, it was very much her right side that showed evidence of damage. She was therefore unable to walk and had limited movement on that side and in her right arm. She received physiotherapy and occupational therapy, but that certainly was not at the minimum level in today’s Royal College of Physicians’ guidelines. Although the people delivering the rehabilitation were good, their time was spread thinly between all the patients and they were present only four days a week, with every Wednesday being taken up with a multidisciplinary team meeting, which meant that there was no rehab directed to patients.

Lynda’s rehab continued at home. That was good while it lasted, but the family were aware of pressure to stop rehab at the earliest opportunity and they felt very much as if they were left alone.

Lynda needed, and often still needs, someone on her left-hand side to support her as she goes about her daily life. Over the years, there has been some recovery of movement in her right side, but that has to be worked on to ensure that it is maintained.

Lynda and her husband Roger are not alone in their experience. It seemed to them at times that, because they lived in a good area and were relatively comfortable, they were abandoned in terms of the care that should have been provided. That gave them the impression that there was very much a postcode lottery regarding aftercare and attention during the recovery period. Therefore, my constituent embarked on committed and tireless work to research stroke aftercare in order to dramatically improve aftercare not only for his wife but for everyone in Scotland. I commend him for the work that he has done.

The 39 per cent decrease in stroke deaths between 2006 and 2016 is to be applauded. I pay tribute to anybody who works in the sector—the physiotherapists, nurses, doctors and clinicians who make sure that individuals are looked after. The challenge that we now face is that around 124,000 individuals are living with the long-term effects of stroke and half of them have a resultant disability. In 2015, the mortality rate for such cerebrovascular diseases was over 40 per cent higher in the most deprived areas of Scotland than in the least deprived postcodes, and people in remote and rural areas, as well as the elderly, face issues with the accessibility of clinical care.

We know that stroke nurses provide wonderful opportunities; they are flexible and provide for health and wellbeing through a holistic approach. They also provide advice on many things including financial issues. That is very welcome, but more needs to be done. There is an urgent need for further investment in high-quality aftercare, with more stroke nurses, support systems and pathways in place in communities such as my region of Mid Scotland and Fife and across the country. That would keep survivors active in order to improve their mobility and wellbeing and it would aid secondary prevention.

I welcome and acknowledge the work that has taken place to date, but there is still much that requires to be achieved for stroke victims and their families if we are truly to tackle the symptoms and to provide aftercare and support. Much more needs to be achieved by the Scottish Government and national health service boards in order to give reassurance to patients and families alike.


Maree Todd (Highlands and Islands) (SNP)

I remind members that I am the co-convener of the cross-party group on heart disease and stroke, and I am also a pharmacist, registered with the General Pharmaceutical Council.

I thank Alexander Stewart for securing the debate. The motion highlights the significance of stroke in Scotland as

“the third common cause of death and the most common cause of severe physical disability among adults”.

Because of the limited time, I will be very focused, and there are loads of things I will not have time to say.

The first and most obvious thing that I will say is that, as parliamentarians, we can both encourage people and create the conditions that make it easy to live healthier lives. If, as a population, we stop smoking, drink less alcohol, eat healthier food and exercise more, we will all be healthier in many ways and we will definitely suffer fewer strokes.

There are a number of conditions that increase the risk of stroke, two of them being hypertension—high blood pressure—and atrial fibrillation. Hypertension contributes to half of all strokes and members may remember that I held a debate raising awareness of that last month. Yesterday, the cross-party group launched an inquiry into atrial fibrillation in Scotland, which I am hoping that my colleague Colin Smyth will tell us more about in his contribution. Tackling such conditions, which significantly increase the risk of stroke, and improving lifestyle more generally will reduce the number of people who suffer strokes. That is the first thing that we need to do.

On the issue of acute care, I welcome the progress we have made in Scotland and I have confidence that we will move rapidly towards equity of access to the best quality of care across the country, as we have done for post-myocardial infarction care. Stroke is the most common cause of disability in the United Kingdom, and more people surviving a stroke means more people living with the long-term effects of stroke, which in some cases means living with severe physical disability. Neuro-rehabilitation from therapists with expertise in acquired brain injury can have a huge impact and I hope that, in the future, more people will be able to access those specialist physiotherapists and speech and language therapists early in recovery.

I will finish by highlighting that June is aphasia awareness month, as approximately a third of people will suffer aphasia after a having stroke. It also gives me the opportunity to talk about some good friends of mine. Edwyn Collins is a Scottish musical legend, most famous for his worldwide hit “A Girl Like You”. In 2005, at the age of 45, he suffered two haemorrhagic strokes, which resulted in aphasia. I spoke to his wife Grace Maxwell last night when I was preparing for the debate, because I know that their story has inspired many people in similar situations.

I encourage everyone in the chamber to watch the film “The Possibilities are Endless” to learn more about Edwyn’s recovery. Grace Maxwell is absolutely passionate about aphasia. She said that it silences people and isolates them. She also said that Edwyn had lived his whole life not caring about what folk said about him, so he has not been silenced by it.

I will finish on a hopeful note. Recovering from a stroke can be really hard work. One of the common myths that we hear about stroke is that all the recovery happens in the first six months to a year. I am sure that that is why the constituents whom Alexander Stewart talked about felt that they had to reduce rehab after that period. Grace Maxwell assures everyone that, 12 years on, Edwyn Collins is still getting better.


Alison Harris (Central Scotland) (Con)

I thank my colleague Alexander Stewart for bringing the subject for debate this evening.

Every 45 minutes someone in Scotland has a stroke. About half of survivors are left with lasting disability. Survival rates continue to improve—the number of people who live after having had a stroke is growing. Therefore, more people than ever need long-term community-based support, which the NHS cannot provide.

Stroke is the biggest cause of disability, and its impact is on physical health and mental health, too, in that it leaves people at risk of anxiety, depression, social isolation and loneliness. In the early post-stroke stage, life cannot be just as it was and people who are affected might need assistance to cope with the frustrations that an enforced new lifestyle can bring. Not being able to do simple or previously enjoyed tasks, a feeling of inadequacy, and dependence on others can all have undermining effects.

The shift by the Scottish Government and the NHS towards self-management within communities is welcome, but it must be matched by investment. Charities including Chest, Heart & Stroke Scotland are key to delivery of such support.

National statistics show a continuing long-term downward trend in Scotland’s mortality rates from stroke, which is welcome and reflects the medical advances that have been made over the past generation; over the decade up to 2016, the mortality rate for stroke decreased by 39 per cent. The challenge now is that more people than ever—some 124,000 in Scotland—are living with the long-term effects of stroke, and half of them have a disability. Given our ageing population, the number will continue to increase.

There are 14,797 stroke survivors in the NHS Lanarkshire area. The NHS is able to treat acute incidents and keep people alive after a stroke, but many people live with the effects for the rest of their lives. The life-changing effects of having a stroke cannot be underestimated, and without on-going support people are more likely to be readmitted to hospital and to visit their general practitioner more frequently.

When people return from hospital they often feel abandoned by the system and have little dedicated support. Third sector organisations such as Chest, Heart & Stroke Scotland pay an increasingly vital role in providing community support.

The Government’s strategic shift is quite rightly away from acute care to community care, and towards people being able to live full lives at home. However, support systems or pathways need to be in place within communities in order to meet that aspiration.

In six health board areas—Highland, Grampian, Fife, Lothian, Dumfries and Galloway and Lanarkshire—Chest, Heart & Stroke Scotland works in partnership with the board to provide specialist stroke nurses. Several other health boards provide stroke nurses, but the scope of their services is more limited. The impact of a stroke on a person clearly goes far beyond the immediate physical implications and extends into every aspect of their life.

Around a quarter of people who have had a stroke are of working age. The third sector has a key role in providing the broader holistic support that people need, which can help them to return to work, if they are able to do so, and can support their families.

Having a stroke causes a person to reassess their lifestyle. It is good to know that organisations such as the Stroke Association and Chest, Heart & Stroke Scotland are there to provide the vital information that people need when they are recovering from a stroke. The debate gives me the opportunity, on behalf of countless others, to thank those organisations for everything that they do to help victims of stroke.


Anas Sarwar (Glasgow) (Lab)

I start by congratulating Alexander Stewart on having secured this important debate. I also thank all our fantastic NHS staff, who go above and beyond in caring for all those who have experienced a stroke or who are living with the consequences of having had a stroke, as well as in supporting families who have been struck by a loved one suffering a stroke and its consequences.

I repeat what Alison Harris said at the end of her speech: I thank third sector organisations, which do a tremendous job, not just in advocating in Parliament on what our policy priorities should be and for advising and briefing us for our speeches, as they do for debates such as this, but for their delivery of care, which so many organisations provide in partnership with the NHS and local authorities.

One such organisation is Chest Heart & Stroke Scotland, which has supported this debate. I also put on record our thanks to the Stroke Association. Many members will have visited the Stroke Association’s reception just a few weeks ago to take part in its purple month, wearing all things purple in order to help to increase the knowledge of stroke and to highlight the risks of high blood pressure. I look forward to welcoming the Stroke Association at its stand here after recess, which will give members an opportunity to check their blood pressure in order to reduce their risk of stroke. I cannot see why any of us would ever have high blood pressure, but somehow it seems to affect us.

I will pick up on a couple of issues that Alexander Stewart raised in his speech, focusing particularly on community care, on our ageing population and on the reduction in the mortality rate from stroke. That means that people are living longer lives, but they are longer and more complicated lives as they live with the consequences of stroke. Indeed, 50 per cent of people with disabilities have had a stroke, and that brings challenges. In total, 124,000 people are living with the consequences of a stroke. That places challenges on community care and on after support, particularly after-support nursing care. It presents challenges relating to other health risks—impacts on physical health and on mental health, including anxiety, depression, social isolation and loneliness.

Some people face challenges around self-management. It is important that we focus on self-management and that we emphasise community care, but that needs to be backed up with investment. There is a postcode lottery in respect of the support and care that people receive in their local authority areas, or in integration joint board or health board areas. We should view the challenges of integrated health and social care also as an opportunity when it comes to what kind of support we can give to communities.

It is also worth noting that, although the mortality rate is falling, the incidence of stroke is predicted to increase by 44 per cent by 2035, according to research that has been done by King’s College. That is a challenge that we need to face head on.

Health inequalities, which have been mentioned briefly, are another key challenge. It is a sad reality that stroke mortality among people from the most deprived backgrounds is 42.3 per cent higher than it is among people from least deprived backgrounds. That gives us real challenges in respect of how we support people—especially in our most deprived communities—to access care when they have a stroke, and to access interventions to limit the risk of their having a stroke in the first place.

We have workforce challenges, too, around care from specialist follow-up nurses. People have access to differing amounts of support depending on which health board area they live in. There are consultant vacancies in specialties involving support for cardiology, and there are specific challenges with thrombectomy. There are only three specialists in that field in Scotland; there are 80 in England and Wales. Unfortunately there is no access to thrombectomy outside Edinburgh and Glasgow. The question how we support people in other areas is crucial.

I end by encouraging all members, please, to come and get their blood pressure checked after the recess.


Alexander Burnett (Aberdeenshire West) (Con)

I congratulate my colleague Alexander Stewart on bringing the motion to Parliament.

Everyone in the chamber will know someone who has been affected by a stroke. As strokes take an unimaginable toll not only on the patient but on their wider family, it is right that we put pressure on the Scottish Government today in order to get the best outcomes for everyone involved.

Unfortunately, we need look no further than the NHS chief executives’ responses to the Scottish stroke care audit report to see that many of Scotland’s NHS boards are underequipped. NHS Ayrshire and Arran cites

“a shortage of stroke consultants”;

NHS Borders cites too small a staff pool; and NHS Dumfries and Galloway cites a lack of “senior doctors”. So it goes on: NHS Fife, again, mentions a shortage of acutely trained staff and NHS Grampian a “reduction in Consultant numbers”, while NHS Lanarkshire says that it struggles to meet new demands.

It is clear that, although the Scottish Government has warm words for stroke patients, it is unable to back them up with results. We face the massive health inequalities that my colleague rightly highlights in his motion. The mortality rates for stroke victims in the most deprived areas is 42 per cent higher than those in the least. In no other illness will you see such a dramatic differentiation in survival.

I am not sure that we fix such a systemic problem by cutting £30 million to health boards such as Grampian. They are underfunded, underequipped and understaffed; a decade of this Government has meant a decade of failure. Given that our health boards are already at breaking point, when will the Government listen or even reflect on these matters? I am all too aware of the disparity in health outcomes in my constituency due to a lack of access to clinical and long-term care. Many constituents have been in touch about the lack of long-term care in remote areas; indeed, it is a widespread problem outside the central belt, but it is a problem that, unfortunately, the Government only ignores.

A most obvious and important example of that is thrombectomy. Although this complex procedure should be available widely, it is not even available outside Glasgow or Edinburgh. The Government’s workforce planning needs to be more imaginative. Clearly, we have a lack of radiologists available to carry out the procedure, but most of the required skills are transferable and cardiologists, for example, could be used instead. We need to be much more flexible in our response to the demands of the future.

For those lucky enough to survive a stroke, a lack of physiotherapy, speech therapy and psychological support awaits. The integration of health and social care presents an opportunity to improve that situation, but it will work only if health and social care work in effective local teams and involve third sector expertise as an equal partner in providing front-line support to stroke survivors.

Finally, other countries measure the availability and effectiveness of long-term rehabilitation, but Scotland does not. Why not?


Colin Smyth (South Scotland) (Lab)

I, too, thank Alexander Stewart for lodging what is an excellent and very comprehensive motion, which provides members with the opportunity to raise awareness of the devastating impact that suffering a stroke has on the lives of far too many of our constituents, the importance of ensuring that they have the appropriate care to recover and the need for us to avoid complacency when it comes to the prevention of strokes.

As the motion highlights, 14,000 people in Scotland suffer a stroke every year. In my home region of Dumfries and Galloway, 4,000 people alone are living with the long-term and often debilitating consequences of strokes while in neighbouring Ayrshire and Arran the figure is more than 10,000. With more people living with a stroke and needing long-term community-based care, there is a need for the Scottish Government to properly fund that support, whether it is provided through local authorities, the NHS or third sector organisations such as Chest Heart & Stroke Scotland. That support includes specialist stroke nurses, who in health board areas such as Dumfries and Galloway are funded through a partnership between Chest Heart & Stroke Scotland and the health board. However, not all health boards support that service, which results in a postcode lottery of care.

Support is also provided by volunteers such as Christina Rafferty in Dumfries, who for the past three years has volunteered with Chest Heart & Stroke Scotland as a core communication and outreach volunteer. Christina works on a weekly basis with a stroke survivor in Dumfries who has difficulty with movement, speech, eating and drinking but who, with Christina’s support, is determined to write again. That story and the invaluable work of volunteers such as Christina highlight just how debilitating a stroke can be and show why doing what we can to prevent strokes is so important.

As members will know, the most common and well-known causes of strokes are hypertension—or high blood pressure, as it is better known—smoking, obesity, high cholesterol, diabetes and excessive alcohol intake. The benefits of a healthy diet and regular exercise in reducing the risk of suffering a stroke cannot be overstated. However, a leading cause of strokes is atrial fibrillation, which increases a person’s risk of having a stroke by around five times. Atrial fibrillation is one of the most common forms of abnormal heart rhythms, and 92,000 people in Scotland are currently diagnosed with that condition. However, with one in four people over the age of 65 developing atrial fibrillation, the actual number of people who live with it is likely to be higher. Not only are sufferers of AF more likely to have a stroke; AF-related strokes are more severe than non-AF-related strokes, and the total care costs in the first year of a stroke are three times higher.

In many cases, the underlying cause of AF is largely unknown. Although some people with AF display symptoms such as palpitations, tiredness, shortness of breath and dizziness, the symptoms can often be very mild, and many people do not display any symptoms. Despite that, determining whether someone could have AF is relatively simple. If a person is at rest, their normal heart rate should be 60 to 100 beats per minute. With atrial fibrillation, the heart rate can often be considerably higher than 100 beats per minute, and each individual beat is erratic. If a person has their pulse checked and assessed, that can give a general practitioner a good indication of whether they could have AF.

AF is not usually life threatening, but the strokes that it could cause may well be. That is why the cross-party group on heart disease and stroke, which I have the pleasure of co-convening with Maree Todd, launched an inquiry last night to consider what steps can be taken to improve the outcomes and experiences for people with AF and their families and carers. The inquiry will look into the diagnosis, treatment and care of people in Scotland who live with that condition.

The first stage of the inquiry was the publication of two surveys last night—one for people who live with the condition and one for clinicians or those who work for an organisation with an interest in AF services in Scotland. I urge anyone who falls into either category to complete a survey—the surveys can be found on the British Heart Foundation website—and I hope that MSPs and anyone who is watching the debate will promote the surveys in their communities.

The consultation period for the inquiry will run until 15 September, and the final report is due to be published in January 2018. I assure members that we will make Parliament very much aware of the outcome of the inquiry.

I thank the British Heart Foundation and the Stroke Association for their work on that inquiry, and Chest Heart & Stroke Scotland and all our fantastic health and social care staff for the work that they do in supporting people who are impacted by conditions such as AF and strokes. We all have a duty to support that work and, better still, to do what we can to reduce the number of strokes in the first place.


The Minister for Public Health and Sport (Aileen Campbell)

Like others, I welcome this debate. I congratulate Alexander Stewart on securing it and on his articulation of Lynda’s story, which highlighted the real need to have a person-centred approach to care and identified improvements that are still required.

I am pleased to know from Maree Todd’s contribution that Edwyn Collins is recovering well. I thank him for his and his family’s efforts in raising awareness of stroke and the incredibly devastating impact that it can have.

Stroke has been a clinical priority for the NHS for some years, and there has been a 39 per cent decrease in mortality from strokes in the past 10 years. That indicates that our strategy for stroke is delivering real benefits. Tackling stroke and its effects should be seen in our overarching aims for public health, which are concerned with prevention, early intervention and supported self-management. That work is integral to the national clinical strategy, which is our high-level vision for how health and social care services will develop over the next 10 to 15 years, and which will be implemented through our health and social care delivery plan.

We are taking action to prevent long-term conditions, including stroke, by addressing the risk factors, which Colin Smyth and other members have identified: smoking, high blood pressure, poor diet, lack of exercise and alcohol consumption above recommended limits. Our heart disease and stroke groups are actively working on ways to improve detection and management of atrial fibrillation and are developing standards and pathways to improve preventative measures. Maree Todd and Colin Smyth mentioned the inquiry by the cross-party group on heart disease and stroke, which is looking at atrial fibrillation, and I am happy to accept any invitation to contribute to that work.

We are improving people’s experience and their clinical outcomes by driving improvement across the stroke care pathway, from acute response to post-hospital support, for anyone who has a stroke. As the motion states, there is well-established evidence that demonstrates the benefits of organised specialist care in improving outcomes after stroke. Our provision is built on that evidence, and we have made a commitment to continuous improvement. The debate about the patient experience that others have mentioned is crucial in that endeavour. It is vital that we acknowledge that although improvements have been made, we always need to do more.

NHS health boards are charged with delivering the level of stroke services that is required in their area, which is informed by local and individual need. We support that through the Scottish stroke care improvement programme, which brings together the people and the information that are needed to drive improvement. The Scottish stroke care audit lets us see where our efforts are achieving the Scottish stroke care standards and where further improvement is required. The stroke improvement team visits all health boards at least annually. It works with the clinical teams and service managers to review stroke care, assess performance, highlight achievements and good practice, and implement local action plans. Together, they seek the improvement in stroke care that we all want.

We have also developed the stroke care bundle, which involves what the clinical evidence tells us are the four core elements that are associated with better patient outcomes. All patients should be admitted to a stroke unit within one day, and they should receive swallowing screening the same day and a brain scan and aspirin within one day. Almost 80 per cent of people in Scotland who were admitted to hospital with a diagnosis of stroke were in a stroke unit within one day. There has also been an increase in the delivery of the bundle, but we remain committed to improving our performance.

Thrombolysis, which is the clot-dissolving treatment that is appropriate for some stroke patients, can increase the likelihood that people who have had a stroke will regain full independence. More people are being thrombolysed more consistently across the country as a result of service expansion, increased use of telemedicine and increasing clinician confidence.

We are keen to identify new opportunities in stroke treatment. Thrombectomy—the removal of the clot from the brain—can offer additional opportunities to reduce the effects of a stroke. The evidence on delivery of that intervention has been building. We are now considering how further thrombectomy for stroke might be enhanced in Scotland. I know that the expert advisory group that is under the auspices of the national advisory committee for stroke recently held an initial meeting to plan for robust consideration of the use of thrombectomy for stroke across the country. We will look at the issues that Anas Sarwar and others have raised about accessibility.

As other members have done, l thank all who are involved in delivering stroke services across Scotland. In particular, I thank them for their contribution to planning thrombectomy. I look forward to seeing the group’s conclusions, and I will make sure that members get sight of those.

Such advances in medical approaches mean that people are far more likely to go back to living an independent life, and they are important in the context of the comments that members have made about the debilitating impact that stroke can have and the intensive care that is required when someone who has had a stroke goes home from hospital. It is important that we continue with those advances in preventative work.

Post-discharge stroke care, which is a key focus of the debate, has also been a key focus of the stroke improvement plan since the outset. We are working with NHS boards and the voluntary sector to help to ensure that people who have had a stroke get access to the care and support that they need to help them to return to independent living. That approach is based on putting patient goals at the centre of care planning.

The stroke improvement plan has been informed and is being delivered by our partners on our national advisory committee for stroke. I recognise the contribution of the Stroke Association and Chest Heart & Stroke Scotland in enabling the experience and voice of patients and carers to inform our work.

Specialist nurses are often part of the range of professionals who help people who have had a stroke to manage their condition. It is up to NHS boards to establish service models that meet the needs of their local population, and care and support can be offered in a multidisciplinary way. A majority of health boards fund stroke nurses who follow up patients post-discharge. Such nurses are employed directly and through joint funding arrangements, in partnership with Chest Heart & Stroke Scotland. The number of clinical specialist nurses increased between 2009 and 2016, but we acknowledge that there is always a need to endeavour to do more.

Allied health professionals, too, play a vital role in caring for those who are affected by stroke. Today, the cabinet secretary launched the active and independent living programme, which will look at how best we can provide people with the support that they need to remain in work and how best to help people to live safely and healthily in their own homes for as long as possible. The vision and the six overarching ambitions for the programme will underpin all future local and national allied health professional activity. The active and independent living programme is supported by funding of £3 million over three years.

Through work with stakeholders, the stroke improvement programme has produced robust practice models of care that can be used by everyone who is involved in the patient pathway, which will improve communication and streamline the patient’s journey. Following that work, it is clear that there has been a significant improvement in the care that is delivered to patients.

A number of members talked about inequalities. They were right to do so, because vulnerable people are the most at risk. Although some have said that there is no improvement, the cerebral vascular disease mortality rate fell in all deprivation quintiles in the 10 years to 2015. However, we must focus on doing what we can to reduce the inequality that too many of our communities face.

Members’ business debates are often consensual, and it is always right and appropriate for members to challenge the Government about its work. However, I hope that Alexander Burnett takes the message about tackling inequalities to his Government, which has often exacerbated inequality. I hope that he is as robust with his Government colleagues in Westminster as he has been with us this evening—as he is entitled to be.

Stroke care is an example of our commitment to a Scotland that has high-quality services with a focus on prevention, early intervention and supported self-management. We remain committed to achieving that and ensuring that people who have had a stroke have access to the best possible care as quickly as possible and to rehabilitation that is based on their personal goals.

I again thank Alexander Stewart for bringing the debate to the Parliament and for articulating Lynda’s story. I hope that we can work together across the parties in the Parliament to make the improvements that I think everyone wants to see.

Meeting closed at 18:06.