Stroke improvement plan: equality impact assessment

5. Recommendations and Conclusion

The EQIA process identified a number of areas where people face variation, differences in accessing services and outcomes following their experience of stroke. As we move forward with the implementation of the Stroke Improvement Plan we will consider how best to address these inequalities.

Regarding age and disability, against a backdrop of an ageing and increasing population of older people with physical and intellectual disabilities, it can be anticipated that there will be a rise in morbidity and mortality from stroke in this group in the future. Tackling risk factors for stroke is Priority 1 in the Stroke Improvement Plan. We will work to prevent stroke, and thus disabling illness, through supporting ongoing primary prevention work commenced in the Heart Disease Action Plan to improve detection, diagnosis and management for the stroke risk factors of high blood pressure, high cholesterol and atrial fibrillation which is person-centred and co-designed.

The recent Scottish study highlights there is gap in our understanding of how those with SMIs experience stroke services.

The Women’s Health Plan (2021) makes specific commitment to provide opportunities for optimisation of cardiovascular health and risk reduction across a woman’s life course. We will continue to work collaboratively to embed the actions within the women’s health plan relevant to cardiac disease and to understand and address the delivery of cardiac services for women in Scotland and where they intersect with stroke care. There is a commitment in the Women’s Health Plan (2021) that all women with heart disease will be provided with individualised advice and co-ordinated care to access safe contraception, abortion, assisted conception, pregnancy and gynaecological care.

With the Scottish Health Needs Assessment (HNA) highlighting that those from the LGBT+ community face health inequalities on every measure of wellbeing, there is a gap in our understanding of how LGBT+ people specifically experience stroke care in Scotland. The HNA contains a number of recommendations including training of health staff and the need for inclusivity of services that more broadly, could support positive change for LGBT+ people who have experienced a stroke. Exclusion from participation and engagement in services is also highlighted, while those experiencing gender reassignment were reported to experience widespread barriers to safe and equitable care.

Engagement with South Asian, African and African Caribbean and Gypsy / Traveller communities needs to be culturally sensitive and take into account experiences of discrimination and unconscious bias to inform how services can be tailored to their needs as well as taking digital literacy support into consideration for a public awareness campaign for stroke. There is a gap in our understanding in how Gypsy traveller communities experience stroke services.

The Race Equality Framework for Scotland 2016 to 2030 also contains a number of goals to support the aim of making Scotland a better, healthier place for everyone and to make real improvements in the lives and experiences of minority ethnic communities in Scotland.

National Stroke Voices

As we move forward to improve stroke care across the whole patient pathway, we will build on the lived experience of the National Stroke Voices to better understand the issues highlighted for these groups to ensure an inclusive approach is adopted to implementing the priorities in the Stroke Improvement Plan.

Priority 2 in the Stroke Improvement Plan focuses on awareness raising to establish the current degree of public understanding of the FAST test (Face Arm Speech Time) to identify stroke symptoms and the action required, and whether certain at-risk groups require different messaging and then to work with third sector organisations to ensure messaging reaches all at-risk groups.

In taking forward these public awareness commitments and the other commitments in the Stroke Improvement Plan, we will work with our stakeholders to make messaging accessible in terms of language, format and medium to reflect the needs of these groups, building on the lived experience of the National Stroke Voices to support positive change for those who have experienced a stroke, to address barriers to engagement and participation and support people to be active partners in their own care.