Stroke Improvement an opportunity we cannot afford to miss

Having a stroke is an alarming and life-changing event, where part of the brain shuts down. It happens to around 10,000 people every year.

There are more than 128,000 people in Scotland living with the effects of their stroke, or over 1,700 for each Parliamentary constituency, if you want to put it that way. Yet despite being one of the major “players” in Scotland’s health and social care landscape, stroke has long been under-served and has never received the at- tention it deserves.

I’m not here to cry over past failings though - we have a unique opportunity to fix this. And stroke improvement can be central to addressing the current funding and capacity crises.

To its credit, the Scottish Government has recognised the problem, and an ambitious Stroke Improvement Programme is underway. A hugely important part of this is the recently published Progressive Stroke Pathway for Scotland, setting out a clear vision of what stroke services and support should be – from action to prevent strokes, to emergency response and acute medical care through to the rehabilitation journey, both in hospital and in the community.

The Stroke Association has welcomed this excellent document, and committed to doing whatever we can to support its implementation. Of course, even the best policy document will not deliver change by itself, and focus must now be on the practical steps necessary to turn this vision into reality for everyone affected by stroke.

Readers of Holyrood magazine will know the challenge. Even before Covid there was too little money and too much to do. Yet this can be a stimulus, not a barrier, to change.

Stroke is the leading cause of disability in Scotland – with almost two thirds of stroke survivors leaving hospital with a disability. So the costs of stroke, both human and financial, extend far beyond the initial event. Getting the immediate response right improves outcomes for stroke survivors, and reduces ongoing support needs. This is most clearly indicated by the example of thrombectomy – a complex and expensive treatment, involving an operation to insert a catheter into the patient’s arteries, to physically grab and remove a blood clot. The procedure so dramatically reduces ongoing support needs for patients that, on average, each thrombectomy performed actually saves the NHS £47,000 over five years.

More generally, the key to effective stroke care is for the patient to move quickly through admission to scans and assessment, so that effective medical interventions can be delivered with the minimum delay. Stroke is time urgent and always a medical emergency - it is in minutes rather than hours that effective stroke interventions must be measured.

Achieving this means having a lot of ducks lined up in a system, subject to host of other pressures.

Only the senior management of Health Boards can do this, making the necessary decisions around policy, joined-up working and resourcing. So we welcome the introduction of a named senior individual in each Board, who will be accountable for delivery of the stroke pathway.

Simple? No. But achievable? Yes.

Our poor outcomes on stroke speak to past failures. Too many people in Scotland have strokes. Too many of those people die or do not receive the right support, quickly enough, and to a sufficient level. Stroke costs us too much, in lives, in well-being and in resources.

Yet this is a uniquely exciting time for stroke in Scotland. The challenge has been laid down for the Health Boards. Improving stroke care isn’t an extra cost – it’s a crucial part of the recovery plan that our health and social care services need.