Hansard

Thank you, Deputy Presiding Officer. First, I thank Gillian Mackay for securing this important members’ business debate, and I thank the Stroke Association for providing a briefing to elected members across the chamber.

We have members’ business debates in the Parliament for a number of reasons, as members are acutely aware. Sometimes, the debate is to highlight an excellent project. Sometimes, the debate is to rightly praise an individual in a member’s constituency or region. Sometimes—as is the case for this evening’s debate—it is to put the spotlight on an issue that does not get enough national airing.

I think that Gillian Mackay has done that tonight. As she and others—including Roz McCall, who made an excellent contribution—said, when people think about stroke, they often think about the physical impacts of a stroke. As Roz McCall rightly said, the physical impacts and impairments that a stroke might cause are not inconsequential, but less is said about the psychological impacts, so I am very grateful, first and foremost, to Gillian Mackay for shining a spotlight on the issue through her motion, and to all the members who have contributed to the debate.

Gillian Mackay spoke about her experience of stroke with her family. She has done that on a number of occasions in the chamber—each time very powerfully. I am also grateful to Roz McCall for sharing her experience in relation to her husband. I wish him all the very best on his recovery journey. My goodness! How difficult that must have been for Roz McCall and her family. It would have been difficult at any time, let alone with the legal restrictions that were in place at the time. She owes us nothing, but her sharing of that story with the Parliament was very powerful and insightful.

I will focus a large part of my remarks on the issue of psychological support and will try to address some of the issues that have been raised by fellow elected members. Addressing the mental health and cognitive impacts of stroke is absolutely a priority for the Government. We are in the midst of developing a new mental health and wellbeing strategy. We should not and will not ignore the long-term mental health impacts of conditions such as stroke. We are absolutely committed to ensuring that patients who have suffered strokes receive the best possible care to enable them to live longer, healthier and more independent lives. Key to that is ensuring that we meet their mental health and cognitive needs as much as we meet their physical needs.

We will liaise as best we can—I certainly try to do this—with people who have been impacted by stroke, whether they have lived experience of suffering a stroke or are a member of the family of someone who has suffered a stroke. We will do that through the national stroke voices group. From listening to the experiences of people who have been affected by stroke and from the findings that the Stroke Association has presented, it is clear that more can be done to address the psychological consequences of stroke.

As several members have mentioned, the Stroke Association’s report references “A Progressive Stroke Pathway”, which was developed by the national advisory committee for stroke, and the recommendations that it makes regarding psychological care. In response to that, the annual reviews of NHS boards’ stroke services will now include a requirement for boards to demonstrate their provision of psychological support for people who have been affected by stroke, in line with the national model of psychological care for stroke. That will ensure that the psychological impacts of stroke are at the front of the minds of our NHS chairs and chief executives when those reviews take place.

Boards will be asked to implement a documented programme for promoting awareness, screening and treatment of the psychological consequences of stroke. Psychological care should be available to all patients who require it, and there should be documented evidence of a clear referral pathway for accessing psychological services. I take the point that a number of members made about their belief that that is not done in a consistent manner. That is why we have set that requirement in relation to the annual reviews. We want to achieve consistency right across the board.

We are also asking boards to ensure that anyone who has suffered a stroke is offered a formal review six months after their stroke event. Support needs to be provided immediately, and we need to make sure that that is followed up.

We know that the psychological consequences of stroke do not always manifest themselves immediately. We have heard that from people who have suffered a stroke and from family members. We hope that that approach will ensure that individuals are able to receive the psychological care that they need when they need it. The provision of psychological care and six-month reviews will be reported in all future Scottish stroke improvement programme annual reports.

I want to turn to a couple of issues that have been raised that I have not covered. Gillian Mackay asked about the stroke improvement plan and when it will be published. I will be happy to update members on that; we are in the midst of that discussion. Obviously, we are under considerable financial constraints, but we want to ensure that there is, when we publish that plan, the consequential funding that will be required for it. I will ensure that we update Gillian Mackay and any other member who has a particular interest.

Roz McCall, Alexander Burnett and other members made an important point about the funding of life-saving thrombectomy services. The point was well made, and I do not disagree with it, but I say to Roz McCall and Alexander Burnett that we are under extreme financial constraints. I will not stray into the reasons for and the politics around that, but really difficult decisions have to be made to deal with high inflation costs and the high pay deals that we have to offer, given the high inflation costs that our workers currently face, which is having an impact on service delivery. However, it should be acknowledged that there is an increase from the previous financial year of almost 20 per cent in forecast thrombectomy expenditure for the current financial year. We will continue to invest in thrombectomy services, because we know—I know as health secretary—their value.

I absolutely accept that delivery of the stroke care bundle is crucial to provision of high-quality stroke care. That is very much emphasised in “A Progressive Stroke Pathway”. Monitoring of performance against the stroke bundle standards through the Scottish stroke care audit allows us to identify where gaps exist. Members will not hear from me denial that there are gaps. There are challenges in delivery of high-quality stroke care and in where we need to implement quality improvements.

I am aware that I am straying slightly over time, Deputy Presiding Officer, but I want to emphasise a final point about the Scottish stroke care audit, which has been raised by a number of colleagues including Paul McLennan and Jackie Baillie. Jackie Baillie was right to point out that it is clear that there are things that we need to improve on. There has been improvement in some areas—for example, in brain imaging and aspirin initiation—but there are many other areas in which we have seen standards slip. That has been largely down to the pressures of the pandemic, but Jackie Baillie was right to mention that there were challenges pre-pandemic, too. She and everybody else in the chamber have my assurance that the psychological support that is needed for people who suffer a stroke is at the forefront of our minds.

I thank Gillian Mackay once again for bringing this important issue to the chamber.