Stroke Improvement Plan

1. Introduction

Context

1. The Better Heart Disease and Stroke Care Action Plan, published by the Scottish Government in 2009 (http://www.scotland.gov.uk/Publications) affirmed heart disease and stroke as a continued priority for NHSScotland. The Plan set out a series of actions across both disease areas that required focus and attention from a variety of partners within the respective clinical communities.

2. Whilst excellent progress has and continues to be made we will always strive to do more to deliver the best possible health and social care and to ensure that the issues we are focusing on continue to reflect current needs.

3. The purpose of this Plan is to ensure that the priorities remain current and by reflecting the progress that has been made, build upon these successes to ensure that in Scotland we continue to strive towards improved prevention, treatment and care of stroke.

4. NHSScotland is a world leader in quality improvement and patient safety. This document sets out plans to implement a quality improvement approach across our clinical priority areas.

Quality Strategy and The Route Map

5. The NHSScotland Quality Strategy (2010) (http://www.scotland.gov.uk) is, and remains, the blueprint for improving the quality of care that patients and carers receive from the NHS across Scotland. It sets out ambitions which acknowledge:

• Putting people at the heart of everything the health service does;
• A focus on providing the best possible care; and
• Recognition that real improvement in quality of care involves all staff, both clinical and non-clinical, working at all levels in all roles.

6. The publication of the Quality Strategy, with its ambition for world class health care, encourages us all to aim for services that at least match the best that can be found elsewhere in the world. The Quality Strategy remains our vision and the anchor point which we should continually reference as we move forward.

7. Building on the Quality Strategy and emphasising the continued commitment to pursuing the three Quality Ambitions of Safe, Effective and Person-centred Care, the Route Map to the 2020 Vision for Health and Social Care (2013) (http://www.scotland.gov.uk) sets out a new and accelerated focus on 12 priority areas for action. The Route Map maintains the focus on improving quality at scale with regard to both health and social care. Working in partnership - across Scottish Government, with the wider public sector, the Third Sector, staff and with patients - has been crucial to our past successes and will remain so as we progress further in our ambition to deliver safe, effective and person-centred care.

Quality Improvement

8. The publication of this Improvement Plan marks an important milestone and further develops previous work. To support improvements in the quality of care we need to recognise where we have been and where we are going. In this context chapter 2 of this Plan provides a short summary of achievements since 2009. In developing this work, whilst recognising the continuity of effort, we also want to ensure a focus going forward on locally-led quality improvement.

9. Since 2013 the Scottish Government has been encouraging the use and implementation of the 3 Step Improvement Framework for Scotland's Public Services (http://www.scotland.gov.uk). This has been supported further by the publication of the Quality Improvement Hub document on 'the spread and sustainability of quality improvement in healthcare' (http://www.qihub.scot.nhs.uk) which identifies the factors that are vital to plan for at the onset of improvement work to optimise spread and sustainability. Further information on the resources available is provided in Annex 3.

10. This approach is not about developing something new but about unlocking and channelling the collective knowledge and energy of people towards a common goal of real and lasting improvement.

11. In line with this Framework, chapter 3 of this Plan sets out clear aims and priorities for stroke. The methodology of the 3 Step Improvement Framework is designed to prompt self-assessment and debate. It is about getting started and 'doing': creating conditions for and implementing the improvements that will make a difference. It is easy to become distracted by a series of assumptions based on how things have always been rather than try something new. It is about encouraging people to work together locally to test and try new approaches. And where successful work with our national advisory structures to ensure that there is spread and sustainability of these approaches.

12. In developing this Improvement Plan we have taken a partnership approach - supported by our National Advisory Committee for Stroke (NACS). Implementation of this work will depend on continued collaboration between all those involved.

13. All aspects of clinical care are important and matter to people living with specific conditions. Therefore, whilst this Improvement Plan focuses energy on specific areas for improvement, it is vital to recognise that many areas of activity which are not being highlighted, are nevertheless issues which will continue to require sustained effort to maintain and continuously improve outcomes for patients.

Network Approach

14. Managed Clinical Networks (MCNs) have a crucial role in the continued development of structures and services to help support and influence the quality improvement of care and are the key vehicle for the delivery of our improvement aims. We encourage Boards to ensure that their MCNs are fit for purpose with a lead clinician working with a network manager to provide strong clinical leadership.

15. MCNs also have a key role in promoting preventative action and tackling inequalities in collaboration with the Health Promoting Health Service (HPHS) programme in hospitals. Access and use of health services is socially patterned with people living in socio-economic deprived areas and at risk of poor health more likely to use services than those living in affluent areas. Preventative action can be integrated within the scope of secondary care with the support of MCNs and influential clinical champions, ensuring pathways for health improvement are built into clinical care to encourage and support positive behaviours and increase access to support and health improvement services.

16. MCNs role in measuring and monitoring the progress of the Improvement Plan priorities is discussed in further detail in chapter 4. This will be supported nationally by the National Advisory Committee for Stroke.

Person-centred Care

17. If care is to be truly person-centred then any improvement work must not just be about health issues but also about social care. Integration of health and social care is the Scottish Government's ambitious programme of reform to improve services for people who use these services and ensure that health and social care provision across Scotland is joined-up and seamless. This Improvement Plan includes priorities relating to living with the condition.

18. As the integration agenda progresses we are committed to ensuring that we work with patients to ensure that any forthcoming priorities reflect their needs. Person-centred care will also mean recognising that many people live with more than one condition, that is have multi-morbidities, and as we take this work forward we must endeavour to ensure a holistic approach to their care.