The Scottish Government have released a summary of its aims and expected outcomes of its stroke improvement plan.
Whilst stroke continues to have a significant impact on individuals in Scotland, however, according to the data included in the summary, the death rate from cerebrovascular disease has decreased by 26 per cent.
Despite this decrease, stroke remains a leading cause of death in Scotland.
The imposed Stroke Improvement Plan contains recommendations made in the Progressive Stroke Pathway, which was produced by the National Advisory Committee for Stroke.
The Scottish Government also note that the Covid-19 pandemic has highlighted challenges for the whole health care system and that it believes “this is an appropriate point to take stock and refresh our commitments on stroke.”
The Stroke Improvement Plan is being implemented in order to support delivery of the “best possible stroke care in Scotland.”
The Government have promised to do this they will consider the entire stroke pathway, from prevention and awareness raising to the provision of rehabilitation and ongoing support.
The main aims of the plan are;
Priority 1: Prevention
We will seek to prevent as many strokes as possible, by working to improve the detection and management of underlying risk factors for stroke.
Priority 2: Awareness raising
We will work to understand current public awareness of stroke symptoms, and the action required when they occur, and support the delivery of FAST campaigns.
Priority 3: Hyperacute care
We will optimise delivery of thrombolysis and expand access to the national thrombectomy service, with the aim of a national round-the-clock thrombectomy service.
Priority 4: Early secondary prevention
We will seek to prevent as many additional strokes as possible by optimising the care of those who have suffered a stroke or TIA.
Priority 5: Rehabilitation
We will make the provision of high quality, holistic rehabilitation a cornerstone of stroke care in Scotland. Rehabilitation should be person-centred, re-accessible, delivered in the appropriate setting and patient outcomes and experiences measured.
Priority 6: Psychological care
We will ensure that the emotional and cognitive needs of those who have survived a stroke are given the same level of importance as their physical needs and recovery.
Priority 7: Collaborative implementation
We will establish a Scottish Government led forum for bringing representatives of every NHS Board stroke service, as well as third sector organisations, together. This will facilitate the sharing of best practice and identify opportunities for collaborative care across NHS Boards.
The Scottish Government have stated that the vision of the Stroke Improvement Plan is of minimising preventable strokes and ensuring timely and equitable access to life-saving treatment. They also state that the plan places renewed emphasis on the importance of the provision of holistic care, particularly in the approach to rehabilitation.
The Government has also listed its options to strengthen the strategy impact on inequalities of outcome, those being:
Within Priority 1: Primary Prevention, we will seek to prevent as many strokes as possible, by working to improve the detection and management of underlying risk factors for stroke.
Benefits are that this work is already underway, via the Scottish Heart Disease Action Plan to implement a community-based awareness, prevention and detection programme for high blood pressure and high cholesterol across Scotland. Improvements in data collection for all three conditions will support local quality improvement within primary care and data should also be made available at regional and national level to identify unwarranted variation, including on the basis of socio-economic deprivation.
Within Priority 5: Rehabilitation, work with Public Health Scotland to develop measures of patient experience and outcomes relating to rehabilitation, with the aim of developing these by the end of 2024.
Key to improving stroke care is ensuring that stroke services address the challenges faced by those who have experienced a stroke. These will enable us to measure the things that are important to people in the delivery of their care, and address unwarranted variation across Scotland, including on the basis of socio-economic deprivation.
It may be difficult to ensure data collection of measures of patient experience and outcomes if we are moving towards more effective use of routinely collected data, as opposed to relying on clinical input.
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