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The Scottish Intercollegiate Guidelines Network (SIGN) guidelines on stroke have been withdrawn due to being over 10 years old. SIGN therefore recommend that healthcare professionals look to other up-to-date evidence-based guidelines to inform practice. A good source is the National Institute of Health and Care Excellence (NICE) evidence search that includes trusted sources from a wide range of organisations: https://www.evidence.nhs.uk/

It has been agreed that a four nations approach will be taken to update the Royal College of Physicians Guidelines for Stroke (2016). SIGN is involved in the development process so that the revised guideline will be a collaborative national guideline which will be applicable for use in Scotland.

The Scottish Stroke Care Audit (SSCA) already measures quality of care of Stroke Services in Scotland against the Scottish Stroke Care Standards. Health Boards are provided with reports on a monthly basis. Performance is monitored locally and nationally and actions agreed to improve delivery of stroke care in Scotland. The most recent annual report can be found here: Scottish stroke improvement programme 2021 national report - Scottish stroke improvement programme - Publications - Public Health Scotland

This is similar to the aims of the Sentinel Stroke National Audit Programme (SSNAP) which measures the quality and organisation of stroke care in the NHS across England, Wales, and Northern Ireland.

Through our Programme for Government commitments we are already reflecting the aims of the European Stroke Organisation’s Stroke Action Plan for Europe.

In particular the ESO’s target that 90% of all patients with stroke in Europe should be treated in a stroke unit as the first level of care is already reflected within the Scottish Stroke Care Standards (Access to Stroke Unit - 90% within 1 day of admission).

The ESO also recommends ‘national plans for stroke encompassing the entire chain of care’. We already have a national plan on stroke - the Stroke Improvement Plan - which we are in the process of refreshing. To do so, we are developing a progressive stroke pathway document which will set out our vision for what stroke services across Scotland should deliver across the entire patient pathway. Following this, a refreshed improvement plan will support its delivery.

Further to the answer given to question S6W-04701 I can confirm that the Case Note review carried out by NHS Greater Glasgow and Clyde along with the report of the peer review undertaken by NHS Lothian have both now been shared with Mrs Slorance.

On 3 November 2020 the Scottish Government published a rapid review of outbreaks to learn lessons for practices within care homes Coronavirus (COVID-19): care home outbreaks - root cause analysis - gov.scot (www.gov.scot)

In doing so, the report collated and evaluated local level experiences and responses to COVID-19 outbreaks within care homes. It identified a number of recommendations to support working practices to prevent transmission of COVID. We continue to work to ensure the recommendations are implemented and have recently set up a working group to examine whether further work is required given where we now are in the pandemic.

Providing consistent high quality, safe and effective personalised care for people is our top priority for our health and care services. We continue to take a public health and a clinical evidence based response to the pandemic. In doing so, this continually ensures working practices are fit for purpose, for example Infection Prevention and Control, Personal Protective Equipment and Testing to Protect which continue to be of paramount importance as we come to deal with the impact of the pandemic and apply lessons learned.

In addition, to support the needs and wellbeing of the social care workforce and unpaid carers, we have put in place a combination of measures including working practices which were outlined in the Adult Social Care Winter Plan available at the following link: Adult social care - winter preparedness plan: 2021-22 - gov.scot (www.gov.scot)

As we look to the future and rebuild and remobilise our social care sector in Scotland, we have a significant opportunity to ensure that staff and users of social care people are placed at the centre of the recovery. We are proactively developing an Older People’s Strategy and a Healthcare Framework for adults and older people living in care homes. These principles will also be critical as we establish a National Care Service in Scotland.

a) NHS Staffing

In all areas of NHS Scotland, a great deal of effort is going into ensuring that services have sufficient capacity to deal with COVID-19, manage other risks and resume planned services as safely and effectively as possible. Although NHS Scotland’s staffing levels are at a record high, following nine years of consecutive growth, we are fully aware of the difficult circumstances that Boards and frontline staff are working in. That is why we have announced a record £300 million of new investment in measures to help services deal with system pressures over winter.

Measures we are taking as part of this investment include the recruitment of 1,000 additional healthcare support staff to support patients in hospitals and in community health teams, as well as £4.5 million of funding to attract registered nurses to Scotland. This activity is supplemented by an additional £1 million to enhance Boards’ capacity for recruitment.

Decisions on local staffing requirements and recruitment are the responsibility of individual NHS Boards. However, Scottish Government officials are continually engaging with NHS Boards to identify particular areas of concern.

(b) Social Care Staffing

The Scottish Government launched a national recruitment campaign on 8 November to attract more people to the social care sector. This campaign emphasises the value of a career within social care by showcasing the benefits of the sector beyond pay, and towards the extrinsic and intrinsic rewards of the role.

Officials are working at pace with SSSC and other key sector partners to develop a national induction programme to support new entrants into Adult Social Care; to promote career opportunities and deliver policies on fair work, upskilling and developing the workforce. This commitment is crucial to improving the experience of the social care workforce and addressing long standing recruitment issues in the sector.

As a result of lobbying efforts from the Scottish Government, the Home Office have temporarily extended the Shortage Occupation List for EU workers. Social care workers, care assistants and home care workers are to become eligible for a health and care visa for a 12-month period.

The Scottish Government will continue to push for a migration system tailored to Scotland’s needs, including a Scottish Visa, and work with partners and employers to develop proposals that suit their requirements.

(c) Public Transport Staffing

For bus service staffing, Transport Scotland and Scottish Government Officials are continuing to work closely with bus service sector representatives and other partners to help facilitate solutions to the staffing pressures brought by the COVID-19 pandemic compounded by the consequences of EU Exit. This has included work to help connect local employability partnerships with bus service operators as well as ensuring that the sector is represented in the Labour and Skills Shortages Action Plan process.

For rail service staffing, due to an increase in COVID-related absences and subsequent disruption in December, ScotRail has put a temporary timetable in place to provide a more stable and reliable service. ScotRail staff COVID-related cancellations have now reduced significantly following the successful introduction of a reduced timetable on 4 January. Around 8% of services have been withdrawn in this temporary timetable – largely additional peak services – leaving a more reliable core timetable in place. It is planned to retain the revised timetable until the end of the month, but ScotRail will keep this under review to balance staffing resources and demand from passengers as best as possible.

The Treatment Time Guarantee already outlines that after a diagnosis is determined and treatment agreed, each health board must ensure that patients receive inpatient and day case treatment within 12 weeks. This applies to all treatments and services apart from fertility treatment, obstetrics services, organ and tissue transplantation, direct referrals to Allied Health Professionals, dental treatment provided by undergraduate dental students, direct access referrals to diagnostic services, and mental health services.

The current unprecedented pressures on the NHS means that Health Boards are not currently able to reinstate services to such a degree as to be in a position to meet the existing waiting times standards and targets, which is why we published the NHS Recovery Plan. This includes a focus on providing alternative pathways of care that will allow people to be treated more quickly closer to home, delivering long term sustainability.

At this time, the Scottish Government has no plans to develop any further waiting time targets for cardiovascular disease.

Where it is clinically appropriate to do so, patients of all ages will be examined with a stethoscope to listen for breathing and heart sounds. They may also have ECG electrical recordings of their heart rate, blood tests and have access to other investigations such as Echocardiograms, rhythm monitors and blood pressure recordings, should these be required.

The Heart Disease Action Plan recognises the need to ensure timely and equitable access to diagnostics, including echocardiography.

As set out within the plan, we are working to address key workforce issues relating to cardiac physiology. Cardiac Physiologists are healthcare professionals who are vital to the delivery of many aspects of cardiac care, including the provision of echocardiography.

Furthermore, we have also recently provided funding for the delivery of a pilot project to improve access to echocardiography. The learning from this will support us in understanding how best to further support improvement across Scotland.

Information on TAVI procedures in Scotland for 2018-19 and 2019-20 was submitted by sites to the UK National Cardiac Audit Programme. Published data is available from the British Cardiovascular Interventional Society (BCIS) - Audit Results - British Cardiovascular Intervention Society (bcis.org.uk) .

The published reports indicate that in 2018-19 there were 310 TAVI procedures, and in 2019-20 there were 400 TAVI procedures carried out in Scotland. The reports do not break down the number of cases per Scottish site.

The Scottish Cardiac Audit Programme is currently working with TAVI sites across Scotland to collate data for 2020-21 onwards.