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Our 10-year Mental Health Strategy was published on 30 March, and sets out our vision of a Scotland where people can get the right help at the right time, expect recovery, and fully enjoy their rights, free from discrimination and stigma.

The Scottish Government has directed NHS Scotland to provide services to all refugees and asylum seekers, including people whose claims for asylum have been refused. Access to good quality health care is important to people who may arrive in Scotland with physical or mental health problems associated with the reasons why they were forced to travel to the UK and claim asylum. A range of specialist health care services have developed in Glasgow to meet the needs of refugees and asylum seekers, including their mental health needs. In 2016, the Scottish Government provided £78,152 to support the Musawa refugee rights and participation mental health project, run by the Mental Health Foundation and Freedom from Torture.

£4.6 million for Healthcare Improvement Scotland (HIS) to work with Boards.

£10 million supporting new ways of improving mental health in primary care.

£15 million supporting better access to CAMHS and innovation.

£1 million supporting people become more active.

£4.2 million to support people in distress who turn to frontline services.

We would expect these improvements in access and support to apply across the population, so that people only have to ask once to get help fast. That particularly applies to groups that are more likely than others in our society to experience mental ill-health and poorer mental wellbeing, such as asylum seekers and refugees.

The Scottish Government believe everyone should have equal access to health care and treatment, regardless of race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition, and that staff should be provided with the support they need to carry out their duties. Under the legal framework for service provision, NHS Boards are responsible for ensuring the provision of primary medical services for their areas. In discharging these statutory obligations Health Boards are required to ensure that care provided to asylum seekers and refugees is consistent with their contractual requirements and the GMC’s Good Medical Practice.

To help NHS healthcare providers, including GP Practices, take decisions where an application for patient registration is received from a patient coming from abroad, we have provided comprehensive guidance through CEL 9 (2010). Under Section 3 of this guidance there is specific reference to Asylum Seekers and Refugees.

Furthermore Health Boards such as NHS Greater Glasgow and Clyde have embedded asylum seeker and refugee services into core functions as part of
mainstreaming equality actions and outcomes for 2016-20. For further information please refer to http://www.nhsggc.org.uk/your-health/health-services/compass/working-with-asylum-seekers-refugees/.

For training to provide Thrombectomy for Stroke (TfS) the established pathway is for a trainee to move from general radiology to sub-speciality neuroradiology training, to sub-speciality training in diagnostics and finally to interventional neuroradiology procedures. The Royal College of Radiologists is developing pathways to train individuals with experience in other endovascular work to perform TfS.

Following an initial meeting in June 2017 a Directors of Planning expert group will lead on progressing plans for the development of a TfS service for Scotland. We would expect the group to take relevant issues, including workforce capacity and training requirements, into consideration as part of this work.

In 2016 the Scottish Stroke Care Standard for brain scanning was made more challenging – 95%, rather than 90% of patients to have a brain scan within 24 hours of admission. In 2016, 93% of patients across Scotland with a final diagnosis of stroke had a brain scan within 24 hours compared with 91% in 2015, a statistically significant improvement.

The following tables show the numbers and percentages of patients with confirmed strokes and receiving a brain scan within 4 hours, from 4 to 8 hours, from 8 to 12 hours, from 12 to 24 hours and over 24 hours, by NHS Board of admitting hospital and NHS Board of residence.

Information is presented by NHS Board of admitting hospital for calendar year 2016, the latest full year currently published in the Scottish Stroke Improvement Programme Annual Report for 2017, available at: http://www.strokeaudit.scot.nhs.uk/Publications/Main.html.

Table 1

Table 2

Table 3

Table 4

Background Information

1. The tables are based on data drawn from eSSCA, the Scottish Stroke Care Audit (SSCA) data collection system.

2. The Scottish Stroke Improvement Programme annual report for 2017 was published on 11th July 2017.

3. Data in the annual report were extracted from eSSCA during March 2017. The data in the tables above were extracted during July 2017 and are, therefore, more up-to-date than the published data. Differences are minor but eSSCA will have changed slightly in the interim as a result of routine day-to-day data processing.

4. Confirmed stroke is based on final diagnosis. eSSCA also collects information on initial diagnosis, where a patient may be suspected of having had a stroke.

5. A small proportion of patients may have had their stroke whilst already admitted to hospital for another reason. For these patients, measurement of the time to their brain scan will start from their symptom onset date/time rather than their admission date/time.

6. The question requests NHS board. SSCA data can be assigned to the NHS board of the hospital treating the patient or the NHS board of the patient, based on their postcode of residence. The treatment and resident NHS boards may differ if, for example, patients travel to another NHS board for specialist treatment. SSCA routinely publishes information based on NHS board of treatment. The table above presents similar information based on the NHS board of residence for the patients involved.

7. The numerators upon which the percentages above are based are shown in the tables above. The denominator in each table is the number of confirmed strokes.

In 2016 the Scottish Stroke Care Standard for brain scanning was made more challenging – 95%, rather than 90%, of patients to have a brain scan within 24 hours of admission. In 2016, 93% of patients across Scotland with a final diagnosis of stroke had a brain scan within 24 hours compared with 91% in 2015, a statistically significant improvement.

For 2016, the latest full year currently published in the Scottish Stroke Improvement Programme Annual Report for 2017, the maximum time in days between admission and brain scan is shown in the following table, for each NHS Board.

All NHS Boards have exception reporting processes in place which highlight patients who do not meet the required standard. These patients’ pathways are actively reviewed by the stroke teams in each NHS Board to ascertain why they did not meet the standard. Where patterns emerge improvement action plans are put in place and changes made to improve delivery of this aspect of stroke care for all patients. Through this exception reporting data capture and analysis limitations which can cause anomalies in the data are also identified, and work progresses to address and correct these.

The table also includes the 90^th percentile, in hours, which shows that 90% of confirmed strokes within Scotland received a brain scan within 21.5 hours, a measure that reflects the experience of the majority of patients with confirmed strokes in each NHS Board.

Table 1

Table 2

Background Information

1. Tables 1 and 2 above are based on data drawn from eSSCA, the Scottish Stroke Care Audit (SSCA) data collection system.

2. The Scottish Stroke Improvement Programme Annual Report for 2017 was published on 11 July 2017 and is available at available at http://www.strokeaudit.scot.nhs.uk/Publications/Main.html.

3. Data in the annual report were extracted from eSSCA during March 2017. The data in Table 1 above were extracted during July 2017 and are, therefore, more up-to-date than the published data. Differences are minor but eSSCA will have changed slightly in the interim as a result of routine day-to-day data processing.

4. Confirmed stroke is based on final diagnosis. eSSCA also collects information on initial diagnosis, where a patient may be suspected of having had a stroke.

5. A small proportion of patients may have had their stroke whilst already admitted to hospital for another reason. For these patients, measurement of the time to their brain scan will start from their symptom onset date/time rather than their admission date/time.

6. The question requests NHS board. SSCA data can be assigned to the NHS board of the hospital treating the patient or the NHS board of the patient, based on their postcode of residence. The treatment and resident NHS boards may differ if, for example, patients travel to another NHS board for specialist treatment. SSCA routinely publishes information based on NHS board of treatment. Table 2 above presents similar information based on the NHS board of residence for the patients involved.

7. The time-based measures are reliant on the presence of both date/time of admission (or date/time of onset for in-hospital strokes) and date/time of scan. If times are missing we are unable to do the calculation other than for scans within 24 hours where we can compare dates even if times are missing. The denominator will include the records with the missing times but the numerator, max and percentile won’t.

The Scottish Stroke Care Improvement Report, is reviewed yearly, and contains different aspects from year to year. We continually look to enhance the report by focussing on different aspects of stroke care. Following feedback from a variety of sources it is planned that this section will return for the next publication.

In addition to the yearly report, all health boards in Scotland do receive monthly reports. These contain prospective data collected locally to be used for management purposes to monitor individual hospital/ Board performance against the Scottish Stroke Care Standards and to drive improvement in the delivery of stroke care across Scotland.

Stroke rehabilitation sprint audits have been conducted as part of the Scottish Stroke Improvement Programme (SSIP) report, published on 11 July.

The Rehab Sprint Audit is focussed on 4 key criteria; Assessment by AHP by 4th day of hospital admission; Multidisciplinary team (MDT) discussion by the 4th day; MDT discussion recorded and accessible; documented evidence that rehabilitation plan has been agreed with patient and / or next of kin. The audit excluded those patients where the hospital stay was less than 2 days or where end of life pathway was deemed the most appropriate.

Further, the Scottish Government approach, highlighted in our Stroke Improvement Plan (SIP), is to focus on the priorities and actions in the SIP on Transition to the Community and Living with Stroke. Stroke Managed Clinical Networks assess themselves against the benchmark criteria. Appendix B of the SSIP report contains further information on pages 55-58.

This information is not held centrally.