Seòmar agus comataidhean

As the First Minister set out on 17th March we have a testing transition plan which will ensure that Scotland continues to have a proportionate and effective testing response as we learn to live with covid.

Where the Government recommends that testing should continue to take place these tests will be provided free of charge.

This process is currently underway. Health Boards have been asked to submit 22-23 plans linked to activity trajectories and requests for funding, which will be used to allocate resources to address orthopaedic surgery waiting lists.

Additionally, as part of our 100 days commitments, we published an NHS Recovery Plan in August 2021. This sets out our plans for health and social are over the next 5 years. Backed by over £1 billion of funding, the Plan will support an increase in inpatient, daycase, and outpatient activity to address the backlogs of care in orthopaedics and other areas, supported by the implementation of sustainable improvements and new models of care.

Women are encouraged to contact their GP practice if they have any worries about possible ovarian cancer symptoms every time cancer symptoms are referred to, including on our public facing website (getcheckedearly.org).

Research is currently being undertaken to better understand the possible barriers and levers to early diagnosis that any new Detect Cancer Early campaigns should focus on. These results are anticipated in April.

Our £44m Detect Cancer Early (DCE) Programme adopts a whole-systems approach to diagnosing and treating cancer as early as possible – ranging from screening and public awareness campaigns to diagnostics and data. The NHS Recovery Plan, published August 2021, commits an additional £20m for the Programme. A symptom-checker tool is included on the DCE website (getcheckedearly.org) to raise awareness of the early signs and symptoms of cancer, including ovarian cancer.

An Early Cancer Diagnosis Programme Board has been formed, Chaired by Dr Catherine Calderwood, National Clinical Director at the Centre for Sustainable Delivery. This group will be responsible for shaping and supporting the delivery of Scotland’s early diagnosis agenda over the coming years, including any additional public awareness campaigns. Research is currently being undertaken to better understand the possible barriers and levers to early diagnosis that any new DCE campaigns should focus on, with results expected in April.

The Scottish Government welcomes the work of the European Stroke Organisation and agree that it is vital to ensure improvements are made to stroke pathways and services, including prevention, treatment and care.

Through our Programme for Government commitments and the Stroke Improvement Plan, we are already reflecting the aims of the European Stroke Organisation’s appeal targets.

We are supporting the National Advisory Committee on Stroke to develop a progressive stroke pathway document which will set out the vision of 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. However, at this time, the Scottish Government does not have plans to use the tracker. The Scottish Stroke Care Audit will continue to track our progress against the Scottish stroke care standards.

The Scottish Stroke Improvement Team have reported on a 12 hour Standard for brain imaging since the Scottish Stroke Improvement Programme National Report (2020). Prior to this, the standard had been within 24 hours. This change in Stroke Standard was in response to a change in the evidence base, with some new treatment regimes being shown to improve outcome when initiated within 12 hours of stroke onset.

Some cases of stroke are time critical emergencies and should be scanned immediately, for instance those patients requiring hyperacute interventions such as thrombolysis and thrombectomy. These specific cases have their own stroke standards on door-to-needle times which ensure that processes are audited and service improvement packages are put in place.

The numbers of confirmed strokes admitted during 2016 - 2021 showing median time (minutes) to brain imaging are shown in the following table:

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.

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 .

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.