Stroke: policy context
From their peak in the 1970s, incidence rates of stroke have steadily declined in Scotland, but not at the pace of neighbouring northern European countries. Stroke will remain a major public health problem in Scotland for several decades to come.
The Scottish Office white paper Towards A Healthier Scotland set a target to half the rate of death from cerebrovascular disease in those aged under 75, in the 15 years between 1995 and 2010. The target was met in 2009.
Scottish Government set a new Treatment Target for 2012/2013, to improve stroke care: 90% of all patients admitted with diagnosis of stroke will be admitted to a stroke unit on the day of admission, or the day following presentation by March 2013 (Treatment Targets for 2012/2013). In the quarter ending March 2013, 80% of patients admitted with a diagnosis of stroke were admitted to a stroke unit within one day of admission.
In light of Scotland's poor record on coronary heart disease (CHD) and stroke, the Scottish Executive published the CHD and stroke strategy for Scotland in October 2002 following the publication of the CHD and Stroke Task Force report a year earlier. The strategy represented the culmination of 4 years' work, based upon extensive consultation with patients, clinicians and managers. The report highlighted CHD and stroke as the major causes of ill-health and death in Scotland, and set out the priorities for stroke treatment: accurate diagnosis, rapid assessment and improved rehabilitation.
Progress of the strategy was reviewed in a supplementary report, Coronary heart disease and stroke in Scotland - Strategy update 2004. One of the strategy recommendations was for all health boards to have managed clinical networks (MCNs) for stroke services, and these have been established.
In Delivering for Health (2005), the section on stroke looks at targets for reducing premature deaths from stroke and the role of specialist stroke units in providing acute and rehabilitative care.
Following consultation (Better Coronary Heart Disease and Stroke Care: a consultation document (2008)), in 2009 the Scottish Government published an updated strategy in the Better heart disease and stroke care action plan.
There have been a number of SIGN guidelines on CHD and stroke, and Guideline 108 'Management of patients with stroke or TIA: Assessment, investigation, immediate management and secondary prevention' was published in December 2008.
The Stroke Improvement Plan (2014) identifies 8 priorities for improvement
- Early recognition of stroke or transient ischaemic attack to maximise access to treatment
- Rapid admission, early diagnosis and treatment to maximise recovery and reduce risk of a future stroke
- Stroke care bundle to ensure all get timely acces to key interventions
- Early diagnosis and treatment for non-admitted patients to ensure timely access to advice and treatment
- Secondary prevention to improve identification and treatment of patients with atrial fibrillation
- Transition to community to support patients living with stroke
- Supported self management and living with stroke to improve patients' well-being and quality of life
- Developing a skilled and knowledgeable workforce to deliver person-centred, safe and effective stroke care