Official Report 1066KB pdf
The next item of business is a members’ business debate on motion S6M-15065, in the name of Roz McCall, on increasing stroke awareness. The debate will be concluded without any question being put.
Motion debated,
That the Parliament notes reports that nearly 11,000 people in Scotland have a stroke every year, including in the Mid Scotland and Fife region; further notes the belief that raising public awareness of stroke signs and the need for immediate action is essential to improving health outcomes for stroke survivors; understands that the FAST (Face, Arms, Speech, Time) stroke awareness campaign undertaken by Chest Heart and Stroke Scotland, which launched on World Stroke Day on 29 October 2024, is aimed at increasing awareness among the public of the need for urgent medical attention for stroke; further understands the importance of repetition in any public health campaign; regrets that there has been no sustained government-backed campaign in Scotland, it understands, since before the COVID-19 pandemic; notes the calls from campaign groups to review public health messaging surrounding awareness of stroke symptoms, including the work of the BE-FAST (Balance, Eyes, Face, Arms, Speech, Time) campaign, which some academic research suggests detects 95.6% of strokes and is the acronym currently favoured by Harvard Medical School and Yale School of Medicine; notes the calls on the Scottish Government to work with Public Health Scotland and NHS boards to trial BE-FAST, in order to assess its effectiveness using data, which, it considers, would allow for informed decisions to be taken regarding the efficacy of current public health messaging, and further notes the hope that all stroke awareness campaigns can continue to increase awareness of the need for urgent medical attention should a patient present with any symptoms associated with stroke.
12:50
I thank members from all parties for supporting my motion and allowing it to be debated.
As members are aware, my interest in stroke comes from personal experience. In 2021, my husband collapsed and it transpired that he had suffered a haemorrhagic stroke. I was aware of the face, arms, speech, time—or FAST—stroke awareness campaign but, because he was lying face down on the floor, it was not possible for me to see the effect that the stroke had had on him. Thankfully, he was processed at speed and that speed, and the skilled hands of the surgeon, saved his life.
Having a stroke is a life-changing event. Stroke affects around 11,000 people in Scotland every year and more than 136,000 people are living with the long-term consequences of stroke. My husband shows signs of stroke fatigue every day and those are far more pronounced on busy days when he has had more to do and is battling internally to complete tasks. The on-going effects of stroke are not widely known and he still gets strange looks when he has to take a little extra time to walk downstairs in public or navigate the aisles of a supermarket.
The Scottish stroke care audit highlighted stroke as the third most common cause of death in Scotland and the most common cause of severe physical disability for adults. The provision of hospital care for those patients accounts for 7 per cent of all national health service beds and 5 per cent of the entire NHS budget.
It does not have to be like that. We know that receiving medical treatment quickly is linked to better treatment, reduced damage and improved outcomes, many of which are clinical, but the Scottish Government has not done enough to make the clinical process faster and more available, especially in our hospitals.
Awareness is also essential and it remains a simple fact that clinical services cannot be efficiently utilised unless we can identify the symptoms of stroke and act fast. Concerning figures from a YouGov poll commissioned by Chest Heart & Stroke Scotland reveal that 39 per cent of adults—a figure that increases to 53 per cent of 18 to 24-year-olds—are not familiar with FAST. That is why I take the opportunity to congratulate organisations such as the Stroke Association and Chest Heart & Stroke Scotland for their continued work to raise awareness.
A special mention must go today to Chest Heart & Stroke Scotland for its current FAST campaign, which illustrates three of the most common symptoms of stroke and highlights the importance of acting quickly to call the emergency services. The F tells us to look at the face and notice whether the person can smile and the A reminds us to check whether the person can lift both arms. The S gets us to check whether the person can speak clearly and the T tells us when it is time to call 999.That campaign has been solely funded by CHSS and, in the first week alone, reached a phenomenal 5.4 million people.
Regular repetition of public health messaging is key, so it is disappointing that it took action by a charity to launch that public campaign, especially when priority number 2 in the Scottish Government’s 2023 stroke improvement plan was awareness raising. The plan stated:
“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.”
I recognise that the pandemic affected public health messaging and that a national campaign might not have had the desired effect when the improvement plan was initially drawn up. However, I ask the cabinet secretary to reflect that we are now in the last months of 2024. Given the alarming statistics that I mentioned in relation to the number of adults who are aware of FAST, I ask the Scottish Government to rethink its approach to public health campaigns.
I could talk on this subject for hours, but I want to take the opportunity before I finish to highlight the work of the BE FAST campaign group, which is working to expand Scotland’s stroke awareness from FAST to BE FAST—balance, eyes, face, arms, speech, time—by adding balance and eyes to the stroke symptoms. That follows the sudden passing of Anthony James Bundy, who was 53 years old when he suffered a fatal stroke with symptoms outside FAST. In that case, clinicians ruled out stroke after various FAST tests were completed, unfortunately leading to that fatal stroke after a five-and-a-half-hour wait in an accident and emergency department in a Scottish hospital.
The crux of the campaign is that less-common symptoms can occur in some individuals, such as changes to balance or the eyes, which could mean misdiagnosis or delay in treatment. I understand the concerns of clinicians and charities that BE FAST may diminish the focus on the three main symptoms of stroke and I understand that the evidence is not yet there to support it, but it is the “yet” that matters. Anything that could prevent loss of life should be looked at seriously. I look forward to the evidence being collated so that, eventually, any loss of life or subsequent disability from stroke becomes a thing of the past.
We move to the open debate and I ask for speeches of up to four minutes. We will start again at 2 pm this afternoon and the staff need time to clear the chamber.
12:56
I thank Roz McCall MSP for bringing this debate to the chamber and for sharing her personal story with us. I know that the subject is close to her heart.
As Roz McCall highlighted, stroke is the third most common cause of death in Scotland and it is on the rise. People are surviving for longer, but those who are suffering stroke are getting younger. A study in Oxford found that, between 2010 and 2018, there was a 67 per cent rise in strokes among under-55s. It also found that there had been a significant rise in the proportion of people in professional and managerial jobs having strokes and it suggested that work-related stress, low physical activity and long working hours could be contributing to that. Blood pressure is the biggest single factor, and the importance of that could be addressed with increased awareness of symptoms of stroke and the risk factors.
Chest Heart & Stroke Scotland has emphasised the importance of regular repetition of public health messaging. As has been noted, 39 per cent of adults in Scotland are unaware of the signs of strokes or the FAST mnemonic. Among 18 to 24-year-olds, the figure goes up to 53 per cent. It is important for people to have that knowledge, because the signs of a stroke do not necessarily look like an emergency. It would be good to hear from the cabinet secretary how the Government will support the campaign and, crucially, how we will engage with younger people. We can all play our part by making sure that we use our platforms to share the campaign widely among our constituents. The more people who are able to recognise the signs of a stroke and take immediate action, the better. Earlier treatment means a greater chance of recovery, and the first three hours are especially crucial.
Roz McCall also discussed the mnemonic BE FAST, which adds balance and eyes. Although that is used in some parts of the US, Chest Heart & Stroke Scotland has suggested that there is just not enough evidence that it works. It points to a previous trial of BE FAST in Scotland that led to a high number of non-stroke issues being identified as emergencies.
Does Evelyn Tweed agree that it is better that people present themselves if they suspect that they may be having a stroke on the basis of the BE FAST mnemonic, rather than not going and ending up where, sadly, too many cases have ended up?
I hear the point that Stephen Kerr is making, but we have to look at everything in the round. If clinicians say that they feel overwhelmed by the use of that terminology, we need to take that into account. I will say more about that.
The situation that I described led in turn to stroke clinicians feeling overwhelmed. Importantly, the symptoms in FAST are specific to stroke—they are unlikely to be anything else. Chest Heart & Stroke Scotland says that the symptoms of posterior strokes, which are more likely to impact eyes and balance, can be mistaken for other things.
Patients need to be triaged effectively to ensure appropriate diagnosis and care. I have heard from my constituents that it took time for their strokes to be diagnosed. In those cases, their symptoms differed from the most common ones.
Although BE FAST may not necessarily be the solution, I am glad to hear that Chest Heart & Stroke Scotland is working with the Scottish Government to expand its education for professionals. That education will include an awareness and understanding of the less common symptoms of stroke that BE FAST incorporates.
The Stroke Association highlights that
“stroke is preventable, treatable and recoverable.”
Indeed, nine out of 10 strokes are preventable. It is also important to raise awareness of preventative measures. For example, two hours of walking per week can reduce the risk of stroke by up to 30 per cent. Two hours of walking a week seems such a small thing to do, but it could have great consequences for people’s health.
Quitting smoking, cutting down on alcohol and eating a balanced diet can all contribute to a lowered stroke risk. Scotland’s 2023—
Ms Tweed, will you please bring your remarks to a close? I have said that there is a bit of time pressure at this session. Thank you.
Thank you, Presiding Officer. I look forward to seeing how work will be taken forward.
13:01
I am delighted to contribute to the debate, and I commend my colleague Roz McCall for securing time to debate what is an important campaign.
When it comes to stroke, time is of the essence. Being able to quickly detect a stroke can mean the difference between a person’s full recovery and the loss of their life. I am therefore delighted to support and assist with the Bundy family’s BE FAST campaign, which seeks to expand the stroke awareness signs by adding balance and eyes to the list of symptoms.
When Tony Bundy suffered a stroke in 2023, the limitations of the current FAST test system meant that his stroke was not detected until too late. Tragically, that meant that Tony Bundy’s stroke was fatal. The lesson that we can learn from Tony’s tragic passing is that the early detection of a stroke can save lives. It is important that the Government listens to the campaign and ensures that future stroke policy is always based on the most up-to-date evidence.
As the BE FAST campaign highlights, a wealth of evidence needs to be considered. For example, the campaign speaks about research by the Scottish Parliament information centre, which found that the FAST test may miss up to 40 per cent of strokes. The BE FAST test may play an important role in the diagnosis of certain types of stroke.
It is safer for someone to decide to go to A and E and be told that they have not had a stroke than for them to sit at home and dismiss their symptoms until it is too late because those symptoms do not fall into the FAST criteria.
Given the compelling case for BE FAST, I believe that there should be a trial of the criteria in the national health service in Scotland. I look forward to the Cabinet Secretary for Health and Social Care covering that in his summing up, because the right decisions at the right time are vitally important. Possibly, a single health board could begin to look at a trial. I know that the Government is keen to listen, and that suggestion was discussed when I met the cabinet secretary and the Bundy family. I hope that the Government is now able to take action and work with Public Health Scotland and other health boards to allow a trial of those criteria to be looked at. A trial period in one health board area could allow data to be collated on the benefits of BE FAST. Data is vital in ensuring that we have facilities and information for stakeholders and those who work in the system, and it could be used to make an informed decision about stroke policy across the whole of the NHS.
Regardless of the outcomes of the BE FAST campaign, it is clear that it has already been effective in shining a light on the importance of stroke awareness. I have felt privileged to help the Bundy family in supporting Tony’s memory. That tragic example shows us all the necessity of such awareness. I have no doubt that members from across the chamber will join me in wishing the whole Bundy family well in the future. I urge the Scottish Government to listen to the campaign and to treat it with the seriousness that it deserves, because saving people is what we should be trying to achieve.
13:05
I thank Roz McCall for bringing this significant issue to the attention of the Parliament. This is an important debate, and I am sure that many members will be able to speak about personal experiences, as it is estimated that more than half of Scotland’s adult population have a close personal connection to someone who has had a stroke.
Given the time constraints, I will not make some of the remarks that I was intending to, as many members have given the reasons why urgency is so important. It is critical that public awareness campaigns that focus on identifying stroke symptoms are supported and, of course, adequately resourced. It will be good to hear what the cabinet secretary has to say about that in his closing remarks.
The national FAST stroke awareness campaign, which is led by Chest Heart & Stroke Scotland, offers a chance to increase awareness of the importance of seeking medical help as soon as possible when people experience stroke symptoms. In the event of a stroke, timing is critical. The treatments of thrombolysis and thrombectomy are time sensitive, so awareness of symptoms is important. In my region, 10 patients received such treatment quickly in a local hospital in the NHS Ayrshire and Arran health board area, so I understand that it is important to invest in public awareness campaigns so that people get to hospitals whenever they can.
Public awareness campaigns are imperative not only in promoting health behaviours but in providing greater awareness of symptoms and the link with improved health outcomes. It is imperative that the Government invests in prevention to improve health outcomes across Scotland, especially in our most deprived communities, because people living in those areas are more likely to have experienced a major cardiovascular event, such as a stroke.
A key aspect of prevention is awareness raising, so the Scottish Government must recognise the importance of health awareness campaigns and listen to charities that are calling on the Government to deliver the priorities that are set out in the “Stroke Improvement Plan 2023”.
We have heard about the very important FAST campaign. Although strokes are generally more prevalent among the older population, the number of younger people who are experiencing strokes is increasing, so we need to make such campaigns accessible to that generation.
Roz McCall’s motion mentions the BE FAST campaign, and I absolutely recognise what she has said in promoting the effectiveness of that campaign. It is encouraging to hear about it, and I urge the Scottish Government to explore the campaign’s effectiveness and to consider how we can add it to our prevention and awareness campaigns.
I hope that the main message from the debate is clear: we need action as soon as possible, and we all want this to be a priority. Therefore, I ask the cabinet secretary to respond favourably.
13:10
I, too, thank Roz McCall for bringing this important debate to the chamber. I echo the thanks to the Bundy family for their campaigning efforts after their own tragedy. I have had the privilege of being invited to their fundraisers and have seen their passion on this topic. Anyone who has listened to James and his mum talk about Anthony would find it difficult to disagree with the real impact that BE FAST would have had in their situation.
As we have heard already, stroke is the leading cause of disability in Scotland, with thousands of individuals and families affected each year. Public health campaigns have proven effective in raising awareness and driving behavioural change, and I echo the thanks that others have given to Chest Heart & Stroke Scotland and the Stroke Association for their work.
To increase stroke awareness, we must invest in targeted campaigns that address specific barriers such as language, cultural differences or misinformation. Working with local authorities and third sector organisations on a local level can amplify their reach and impact. Figures provided by Chest Heart & Stroke Scotland show that, each year, nearly 11,000 people in Scotland suffer a stroke, with around 136,000 people living with the on-going effects.
Stroke remains one of the leading causes of disability in our country, yet public awareness of its symptoms remains worryingly low. Research by Chest Heart & Stroke Scotland shows that 39 per cent of adults in Scotland are unfamiliar with the FAST test, which is an essential tool for recognising stroke symptoms. Alarmingly, that figure rises to 53 per cent among younger adults aged 18 to 24. That is especially concerning because quick medical intervention is crucial, as it significantly reduces long-term damage and improves outcomes. That highlights why raising public awareness of stroke signs and the urgency of seeking immediate help must remain a priority.
The Scottish Government’s progressive stroke pathway and the UK-wide national clinical guideline for stroke emphasise the importance of campaigns such as FAST, which play a vital role in saving lives and improving health outcomes.
Campaigns such as FAST and BE FAST play a crucial role in raising awareness of symptoms. FAST focuses on face drooping, arm weakness, speech difficulties and the need for time to call emergency services, while BE FAST expands that to include balance issues and eyesight changes as additional warning signs.
Although BE FAST aims to capture a broader range of stroke symptoms, there is disagreement on the implementation of FAST versus BE FAST, with many people citing a lack of research on the efficacy of BE FAST and how using it might affect capacity in A and E departments. That is why I believe that further research and a further pilot scheme are needed to determine whether that expanded approach can improve overall outcomes. We can learn from the previous pilot, and I do not think that some of the issues that have been raised are entirely insurmountable, so they should be worked on. A consensus on the best way forward has to ensure that we maximise the impact on saving lives.
The Stroke Association has shared data that paints a stark picture of the challenges that Scotland faces in stroke care after people have had a stroke. In 2023, only one in seven eligible patients received a thrombectomy. Thrombectomy is 100 per cent cost effective and saves Scotland’s NHS £47,000 per patient. The Stroke Association’s report, “Scotland’s Stroke Improvement Plan—One year on. How’s it going?”, highlights key areas of concern arising from the Scottish stroke care audit. It shows that basic care delivery is falling short, with only 51 per cent of patients in 2023 receiving the stroke care bundle within the national standard, down from 64 per cent in 2019, and with NHS Forth Valley performing at a level of just 40.6 per cent. It also shows that we must invest in more psychological and rehabilitation support for stroke survivors, with all health boards currently falling into amber or red in delivery ratings and too many patients left without six-month recovery plan reviews.
In conclusion, we must ensure that investment in stroke care is improved. Better prevention, faster treatment and stronger recovery services will save lives, reduce costs and ensure better outcomes for patients and their families.
13:14
I refer members to my entry in the register of members’ interests, which states that I am a practising GP.
I thank my colleague Roz McCall for bringing the crucial issue of stroke awareness to the chamber. We have already heard that, each year, 11,000 people in Scotland suffer a stroke, with more than 136,000 people living with its lasting effects.
Stroke is a medical emergency, and recognising the signs early is essential. Stroke happens when blood flow to the brain is interrupted, which leads to a sudden loss of brain function. Quick action can make all the difference, helping people recover with less brain damage and reducing long-term disability.
As a doctor who worked at the hyperacute stroke unit in the Glasgow royal infirmary, I have seen at first hand how critical early recognition of stroke symptoms is, and how vital early treatment and rehabilitation is. In response to what Evelyn Tweed said, we saw only confirmed stroke cases and the people who came in the front door were reviewed by a clinician. It is essential that it is our job to do the evaluation and that we do not rely on patients’ googling abilities.
When people seek medical help immediately, their chances of recovery are much higher but, unfortunately, awareness of stroke symptoms remains worryingly low. According to recent research, 39 per cent of adults in Scotland do not know FAST. In younger adults, that figure rises to more than 50 per cent. That simply is not good enough, and we need to do more. A lack of public knowledge can lead to delayed help and devastating outcomes for individuals and families, and that is why raising awareness is essential.
Thanks to Chest Heart & Stroke Scotland, we have the FAST campaign, which is Scotland’s first public stroke awareness initiative since the pandemic and I applaud it for that. The campaign promotes the FAST acronym to help people to recognise quickly the three most common stroke symptoms—facial drooping, arm weakness and slurred speech. The T stands for time, and it reminds us of the urgency of calling 999, as time is brain cells.
Although the FAST campaign has helped many people to recognise stroke symptoms and act quickly, it does not cover all possible indicators. Some people experience symptoms beyond the FAST guidelines, and their stroke goes undiagnosed. One example that we have already heard about today is Tony Bundy. Last year, Tony became seriously unwell while out shopping in Glasgow. His symptoms included balance issues, visual problems, cold sweats and vomiting. Obviously, none of those matched the FAST symptoms. Because of that, stroke was not diagnosed, and Tony went hours without receiving proper treatment. Tragically, he lost his life due to the undiagnosed stroke.
Since his passing, Tony’s son, Councillor James Bundy, has been advocating for expanding Scotland’s stroke guidelines to BE FAST, which would add balance and eyes as additional signs to watch for. We know about the danger of false negatives, where stroke goes undiagnosed because it does not match the FAST symptoms, and Councillor Bundy believes that BE FAST would lead to fewer false negatives. The Bundy family believes that, if BE FAST had been in place, Tony’s symptoms might have been recognised sooner, potentially saving his life. Some argue that BE FAST could lead to emergency services handling more non-stroke cases, but it potentially saves lives and spares families from heartbreak.
Roz McCall spoke about evidence. A meta-analysis of BE FAST shows that it has a higher diagnostic value, with a specificity of 0.85. If I might be indulged, BE FAST symptoms of balance and eyes are things that concentrate on the posterior circulation, and centres in the United States use BE FAST.
It is crucial that clinicians are aware of BE FAST, as it increases stroke awareness. As a general practitioner, I want people to come to me when they experience problems with their balance and eyes in an acute way, because that is my job. It is the job of a doctor to make the decision on whether somebody needs a CT scan.
Expanding BE FAST could help to save lives. Every moment in stroke counts, and, with increased awareness, we can ensure that more people get the help that they need.
13:19
I am grateful for the privilege of speaking in the debate, to Roz McCall for bringing the motion and to Dr Sandesh Gulhane for the speech that he just made.
As many members will know, James Bundy works in my office, and I am delighted to welcome him and his mum, Selena, to the public gallery. I am going to give my voice to James—these are his words. He says:
“My family and I want to thank all MSPs who have given support to BE FAST and celebrate the fact that we have support from representatives from all parties elected in the 2021 elections.
I also want to express my family’s gratitude to Neil Gray and Jenni Minto for meeting us to discuss BE FAST, as well as members of the Stroke Association and Chest, Heart, and Stroke Scotland.
This gratitude, however, is mixed with growing frustrations. Ever since our first meetings with the Scottish Government and stroke charities, we have felt that not enough consideration has been given to the devastating consequences of ‘false negatives’.
My family and I feel like donkeys chasing a carrot. Initially, we were told BE FAST couldn’t be used in Scotland due to a lack of evidence of its effectiveness in live medical settings.
When we presented evidence from Australia showing successful trials, the excuse shifted to the lack of Scottish trials.
Yet, when we request a trial in Scotland, there’s apparently no appetite for it from Government or the stroke charities.
How can we gather Scottish evidence if those in charge refuse to trial BE FAST?
While my family understand concerns about ‘false positives’, we cannot view this issue through that lens alone.
The status quo is costing lives. People, like my Dad, are dying because strokes are not being diagnosed. Some stay at home, unsure they are having a stroke, while others are left in hospital corridors because a stroke is ruled out by medical professionals.
This is not good enough and cannot continue.
My Dad’s story is not unique. Running this campaign, I have spoken to people across Scotland and the rest of the United Kingdom who have been let down by the restrictions of FAST.
Two family friends, informed about BE FAST through my family’s campaign, received vital care despite having no FAST symptoms.
One lost her balance and was diagnosed with a TIA at A&E, while another lost the ability to stand, and their eyes were struggling to focus. To the shock of her doctor at NHS Forth Valley, a TIA was confirmed.
No FAST symptoms, but they received the treatment that they needed because of BE FAST.
While I am proud of my family’s efforts to promote BE FAST, running a public health campaign isn’t our role—it’s the Scottish Government’s responsibility.
My Dad, Anthony James Bundy, was a great man taken from us far too soon. He missed my wedding last month, his 25th wedding anniversary with my mum, and many more, and the chance to see the business he launched months before his passing flourish.
These moments were stolen from him, and from my family, because of the limitations of FAST—limitations known to those responsible for stroke care in Scotland.
My Dad was a man who wanted to set things right. Learning this trait from him is probably the reason why I am working in politics.
Expanding FAST to BE FAST won’t bring my Dad back. It won’t make things right for my family. But what it will do is make things better for my fellow Scots by helping save countless lives across Scotland.”
Those were James’s words—these are mine. I know that the cabinet secretary is a good fellow, and I know that he has a good heart. So I ask him today, on behalf of this family—and countless other people in Scotland on the wrong end of the misdiagnoses that are occurring because of the lack of awareness of BE FAST—to launch a Scottish trial of BE FAST, so that we can assess its effectiveness in Scotland.
13:23
First, I put on record my thanks to Roz McCall for bringing this debate to the chamber and for reminding us that stroke can affect any one of us. Like so many others who have contributed to the debate, I have a very close family experience of someone who had a stroke just this summer. Mercifully, they are making a pretty good recovery, but I recognise that for too many, including the Bundy family, that is not the case, and that stroke can lead to tragic and sudden loss.
I welcome the launch of Chest Heart & Stroke Scotland’s FAST campaign. It and other stroke charities, such as the Stroke Association, do vital work in raising awareness and supporting people who have suffered a stroke, and I want to thank them for that.
I say at the outset that I recognise and regret the fact that there has been no Government-backed stroke awareness campaign in Scotland for some time. Although our financial position remains difficult, my hope is that the Scottish Government can revisit whether a stroke awareness campaign next year will add value to the excellent work that is being carried out by Chest Heart & Stroke Scotland, as well as the work of the Stroke Association and other charities, which has been referenced by others from across the chamber.
It is clear that colleagues across the chamber recognise the importance of raising awareness of stroke. Roz McCall shared her personal story, for which I am very grateful; it is not easy to share in public stories about private issues. She made a strong point about the speed of response, which was also mentioned by others, and reinforced the need for greater awareness of FAST—face, arms, speech, time. I welcome her support regarding the importance of public awareness-raising campaigns and public health marketing campaigns.
Evelyn Tweed recognised some of the things that contribute to a greater risk of stroke. Interventions such as lifestyle changes that address issues such as blood pressure form a clear part of the reform and improvement work that I want our health service to do to prevent stroke. We have spoken clearly about the need for speed of reaction when stroke symptoms are present, but Evelyn Tweed’s point about the requirements for preventing stroke is also incredibly important.
Does the cabinet secretary recognise that, for some people, stroke is not a preventable event and that they need timely support regardless of whether we can prevent all strokes?
I absolutely recognise that there are circumstances in which stroke is not preventable, but there are also contributing factors that make for a greater likelihood of stroke. From the public health perspective, we are seeking to make greater progress on those areas, but I recognise the point that Gillian Mackay made.
Carol Mochan gave a good example of the work that is taking place in Ayrshire and Arran. It was helpful to hear that. I am aware that the Minister for Public Health and Women’s Health is due to visit thrombectomy services early in the new year. I agree with Carol Mochan about the interaction with health inequalities in this space. The point that I was making, and that Gillian Mackay responded to, is absolutely prevalent, and it is an issue that I am determined that we will do more to respond to.
Gillian Mackay was also correct about the mixed views on BE FAST, which Sandesh Gulhane also referenced.
When the Stroke Association and Chest Heart & Stroke Scotland submitted information to the Citizen Participation and Public Petitions Committee, they asked for further evidence, and they needed further evidence. Surely that gives us the opportunity to get evidence and have a trial, which is what the motion suggests that we do.
I am not closed to the campaign by the Bundy family and others, or to the points that have been raised by Alexander Stewart, Stephen Kerr and others. I will come back to that.
Sandesh Gulhane, who knows about the issue from his work in a clinical setting, was right about quick action making a huge difference, which is why I will turn to our actions shortly.
I am grateful to Stephen Kerr for giving voice to the Bundy family and to James Bundy, who is in the public gallery. I heard that voice clearly in the meeting that I attended, which was hosted by Alexander Stewart. The passion, compassion and determination of the family, which I recognised in a very emotional speech that Stephen Kerr gave, give us all pause for thought.
I turn to the actions that we are seeking to take as a result of some of the interventions that have come from the Bundy family. I met the Bundy family in April, along with Alexander Stewart and the Scottish Government’s specialty adviser for stroke. I was struck and moved by the family’s determination to ensure that no one else has to go through what they have experienced. Again, I offer them my very deepest condolences for their loss. It is clear from Stephen Kerr’s words, and the reflections that he shared with me in that meeting, how loved Mr Bundy was and how keenly his loss is still felt—I recognise that very much. For anyone who has lost close family members in sudden and tragic circumstances, that loss is felt even more keenly.
We all want people who may be having a stroke to be identified more quickly so that they can get the care that they need. That includes ensuring that healthcare staff are aware of less common stroke symptoms, and I will say more about what we are doing in that regard. We do not plan to replace FAST with BE FAST at this time. It is important that I clearly explain why, not least because of the powerful contributions from Alexander Stewart, Roz McCall, Stephen Kerr and others.
Our approach to stroke recognition must always be informed by the best clinical advice, and the clinical advice in this instance is that more evidence is needed before an expert decision can be made on stroke symptoms that are not currently included in FAST. That view is shared by Chest Heart & Stroke Scotland and the Stroke Association. Importantly, that stance is aligned with the rest of the nations in the United Kingdom.
We do not plan to run trials of BE FAST in NHS boards. That is a decision for each board, but I keep that situation under review. I have asked the national advisory committee for stroke to keep the emerging evidence on stroke awareness screening under review and advise the Scottish Government if new evidence suggests that changes may be needed.
I turn to the action that we are taking now, which came directly after the meeting that I had with the Bundy family. After that meeting, I asked the specialty adviser for stroke to review the stroke awareness training for clinical staff, a point that was raised by Sandesh Gulhane and Evelyn Tweed. As a result, we are funding new training to help staff recognise stroke symptoms, which will be delivered by Chest Heart & Stroke Scotland. That includes recognising less recognisable symptoms, as was asked for by Evelyn Tweed in her contribution. The training will be available to general practices, emergency departments and the Scottish Ambulance Service.
Although we are focusing on FAST, that resource will also cover less common stroke symptoms such as blurred or double vision and loss of balance. The Minister for Public Health and Women’s Health has written to all NHS boards to ask them to encourage their staff to sign up when the training becomes available. We have also carried out polling to understand the current level of public awareness of the FAST symptoms. That will inform our future approach to awareness raising on stroke. Furthermore, recognising that tests such as FAST and BE FAST can never be 100 per cent accurate, we are also supporting the Scottish Ambulance Service to explore using video call technology to diagnose hyperacute strokes more accurately.
The Scottish Government recognises the importance of ensuring that less common stroke symptoms are not missed. The harrowing, tragic and traumatic case of the Bundy family is an example of that. We are taking action to improve education and support more accurate diagnosis, and we will continue to monitor the evidence base on stroke recognition to ensure that our approach is informed by the best available evidence.
I once again thank everybody for contributing to what has been a valuable and moving debate, and all those who have contributed to the campaign getting to this point. I am very grateful for that. The actions that are being taken by staff and campaigners are helping to save and change lives, and I am immensely grateful for everyone’s contribution.
That concludes the debate.
13:33 Meeting suspended.Air ais
Point of OrderAir adhart
Portfolio Question Time