Stroke improvement plan 2023

2. Introduction

Cerebrovascular disease (CVD) develops as a result of problems with the blood vessels supplying the brain. These can include strokes caused by clots (ischaemic) or those caused by bleeding (haemorrhagic). Additionally, some individuals may experience Transient Ischaemic Attacks (TIAs), which are caused by a temporary disruption in the blood supply to the brain.

The onset of a stroke is a sudden, life-threatening medical emergency and urgent treatment of a stroke is essential. The sooner treatment is received, the better a person's chance of making a good recovery and avoiding serious disability.

Over the last decade, the death rate from cerebrovascular disease has decreased by 26%. However, stroke remains a leading cause of death in Scotland. There were 3,836 deaths in Scotland in 2021 where CVD, including stroke, was the underlying cause (Scottish Stroke Statistics).

Despite the decline in death rate, stroke continues to have a marked impact on people across Scotland. Stroke is a leading cause of profound adult disability, and the consequences of a stroke are often long-lasting and almost always life changing. Over 128,000^[[1] stroke survivors live in Scotland and the effects of stroke are felt by individuals who have suffered a stroke, as well as their friends, families and those with caring responsibilities. The Scottish Government is committed to maximising the number of individuals who survive strokes and to ensuring that stroke survivors have the best possible care and quality of life.

In addition to the long-term impacts of stroke, more people are living with long-term conditions such as cardiovascular disease, neurological conditions, chronic respiratory conditions and diabetes, as captured in the Scottish Burden of Disease data. Each of these conditions requires ongoing treatment and care and has a subsequent impact at each stage of the treatment of, and recovery from, stroke.

In order that those who have experienced stroke are best placed to navigate their stroke journey, stroke care should be provided in line with the principles of realistic medicine. This includes:

• Listening to and understanding patients' problems and care preferences.
• Ensuring that decision making is shared between patients and their healthcare professionals.
• Ensuring that patients have access to the clear and understandable information required to make an informed choice about their care.

These tenets of realistic medicine, and the provision of care that is person-centred and tailored to the needs of the individual, should be applied by stroke services at all stages of stroke treatment and care.

The Stroke Improvement Plan (2014) set out a comprehensive programme for further reducing the number of deaths from stroke and improving stroke care across the whole patient pathway. The Scottish Government remains committed to further improving stroke care across the entire stroke pathway.

To this end, a refreshed Stroke Improvement Plan is required to build on the work achieved by the previous plan. The Stroke Improvement Plan (2023) builds on the existing Stroke Improvement Plan (2014) and sets out the Scottish Government's priority actions in continuing to improve stroke care. This refresh of the Stroke Improvement Plan takes account of changes in clinical practice, the emergence of treatments and input from those with lived experience of stroke. The Stroke Improvement Plan considers recommendations made in the Progressive Stroke Pathway, produced by the National Advisory Committee for Stroke.

Through this refreshed Stroke Improvement Plan, the Scottish Government recognises the impact stroke has across Scotland. This plan reiterates our commitment to improving stroke care and raising the profile of stroke and its consequences. We have renewed our ambitions, particularly in commitment to life-changing treatment such as thrombectomy and a greater emphasis on the importance of high-quality rehabilitation. We will work closely with all stakeholders, including NHS Boards, clinicians, third sector organisations and those with lived experience of stroke to implement this plan.