Meeting of the Parliament 21 June 2017
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.