Seòmar agus comataidhean

Planning of community rehabilitation delivery is the responsibility of individual NHS Boards and Health and Social Care Partnerships.

Our vision is for everyone with rehabilitation needs to be able to access the care and support they need to live well, on their own terms. Exploring ways to improve access to rehabilitation is a key aspect of the work underway to develop a progressive stroke pathway document.

With regard to measuring performance, the provision of appropriate rehabilitation, in both acute and community settings, currently forms part of the Scottish Stroke Improvement Programme (SSIP) criteria-based assessments.

These are currently being reviewed and expanded and will form part of the regular reviews which are undertaken by the Scottish Stroke Improvement Programme team with each Health and Social Care Partnership. We will also consider how these might be integrated into the Scottish Stroke Care Audit if effective.

I refer the member to the answer to question S6W-05487 on 21 January 2022. All answers to written Parliamentary Questions are available on the Parliament's website, the search facility for which can be found at https://www.parliament.scot/chamber-and-committees/written-questions-and-answers

There is evidence that access to a stroke unit improves outcome for stroke patients.

The Scottish Stroke Care Audit (SSCA) monitors the quality of care provided by the hospitals in all NHS Boards and access to a stroke unit is a standard measured by SSCA, alongside other standards associated with improved patient outcomes. Performance against the standards, and more detail on service models can be found here:

Scottish stroke improvement programme 2021 national report - Scottish stroke improvement programme - Publications - Public Health Scotland .

There are a wide range of definitions for Stroke Units and it is understandable that stroke units will look very different between, for instance, a large city hospital and island NHS Boards

The core criteria for defining a stroke unit are well described in the academic literature, including in Langhorne et al (2002). Professor Langhorne is a member of the Scottish Stroke Care Audit (SSCA) Team and has been influential in defining different models of stroke unit care.

NHS Boards are expected to describe their stroke unit models through the SSCA processes and the Scottish Stroke Improvement Programme Team review this information during Board Reviews (now occurring at least twice annually). This ensures that optimal and evidence based services are being delivered and demonstrates that stroke units are viewed as a core component of care.

The number of confirmed strokes discharged during 2021 showing total length of stay and length of stay in a stroke unit is in the following table.

For some of the figures, the length of stay in the stroke unit are longer compared to stay in the audit. The patient may have completed the stroke part of their journey, but they did not have a discharge plan, so would be discharged from the audit. However, they are still in the stroke unit, for example if they have another condition that is more important than stroke.

We are supporting the National Advisory Committee on Stroke to develop a progressive stroke pathway document which will set out the vision for what stroke services across Scotland should deliver across the whole patient pathway, including access to stroke rehabilitation, and access to support for people who have experienced a stroke.

Scottish Government will work closely with the Stroke Improvement Programme Team and stakeholders throughout 2022 to develop an implementation plan to deliver the vision set out in this document.

We will continue to take steps to introduce a high quality and clinically safe thrombectomy service in Scotland. A Scotland wide service is expected to be operational by 2023.

Guidelines are intended as an aid to clinical judgement, not to replace it. The ultimate decision about a particular clinical procedure or treatment will always depend on each individual patient’s condition, circumstances and wishes, and the clinical judgement of the healthcare team.

Scottish Intercollegiate Guidelines Network (SIGN) have taken the opportunity to take a four nations approach and collaborate with the Intercollegiate Stroke Working Party on the 6th edition of the Royal College of Physicians National Clinical Guideline for Stroke which is expected to be published in February 2023. This will be a collaborative national guideline which will be applicable for use in Scotland.

The Scottish Government is committed to ensuring that all children and young people are able to access the right support for their mental health without stigma, including medication where this is the most appropriate intervention.

The Scottish Government does not hold data on the numbers of children and young people who have been offered talking therapy or who have refused talking therapy as a treatment option.

Prescribing is a clinical decision based on a prescriber’s judgment as to what they believe to be in the best interests of the patient. The prescribing of antidepressants to children and young people is undertaken in consultation with the patient and, where appropriate, with their family, to ensure that patient choice is also central to decisions taken regarding treatment and care.

Medication is one aspect of treatment, alongside psychological therapy or other therapeutic interventions, available as an option for children and young people who require support. We continue to invest and improve access to other services, including by providing £16 million per annum to ensure that every secondary school in Scotland has access to counselling support; and by investing £15 million in community-based mental health and wellbeing services as part of our focus on early intervention and prevention.

This information is not held centrally.

The Government is clear that the intended purpose of the revised payment arrangements from April 2022 is to recover NHS dental services to ensure that NHS dental contractors can provide necessary care to patients.

NHS dental contractors will therefore receive a multiplier payment in addition to the value of their actual item of service claims. This is part of a blended system of payments which also includes allowance payments, capitation and continuing care and direct reimbursement of expenses such as rental costs. The multiplier arrangement is a fair and equitable response to the current situation of restrictions facing dentistry by returning discretion of earnings back to independent NHS dental contractors.

Every three months the value of the multiplier will be set against concurrent infection, prevention and control restrictions, levels of dental activity and other budgetary considerations at the time of the review point. The purpose of these revised arrangements is to continue to provide appropriate financial support to NHS dental contractors and is therefore assisting in ongoing business planning.