Chamber and committees

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.

Through a number of initiatives, such as the Professional Careers Programme, we are actively supporting individuals living with a disability to realise their ambitions of working for the NHS in Scotland. This programme, developed in partnership between the Scottish Government, NHS Scotland and a number of equalities organisations, offers a range of employment opportunities.

Additionally, on behalf of the Scottish Government, the Scottish Social Services Council (SSSC), provides resources, through various sources, to promote career opportunities for people from all backgrounds in the social care sector in Scotland.

In December 2016, the Scottish Government published our Disability Delivery Plan, A Fairer Scotland for Disabled People, through which we have given a specific commitment to provide further tools and guidance to support Health Boards deliver the Learning Disability Employment Programme.

The Scottish Government is determined to show leadership in advancing race equality in Scotland. Through the Race Equality Framework we have identified a number of actions to promote the participation of traditionally underrepresented groups in all arenas of Scottish life, including two specific actions to promote the participation of black and minority ethnic people within the NHS and social care workforces.

We work actively with NHS Boards to promote equality and diversity issues, which are underpinned by fair and inclusive recruitment policies, supported by clear and unequivocal Staff Governance Standards.

Furthermore, on behalf of the Scottish Government, the Scottish Social Services Council (SSSC) provides a range of resources, through various sources, to promote career opportunities for people from all backgrounds in the social care sector in Scotland.

This information is not held centrally.

The Scottish Government and NHS Scotland actively promote the participation of traditionally underrepresented groups within the NHS workforce; this is underpinned by fair and inclusive recruitment policies, supported by clear and unequivocal Staff Governance Standards.

Our nationally agreed Partnership Information Network (PIN) policy “Embracing Equality, Diversity and Human Rights” was published in December 2013 (available at http://www.gov.scot/Publications/2013/12/3747). This policy, developed in partnership with NHS Boards and employee representatives, is explicitly designed to further embed a culture that promotes equality and values diversity.

More broadly, the Scottish Government is committed to showing leadership in advancing race equality in Scotland. Through the Race Equality Framework we are taking forward a series of actions that seek to eradicate the barriers faced by people from minority ethnic backgrounds. This includes specific actions to increase BME participation in the health and social care workforces, and requires Health Boards to provide relevant equality and diversity training for their staff.

The Scottish Government and NHS Scotland actively promote employment for individuals living with a disability within the NHS workforce; this is underpinned by fair and inclusive recruitment policies, supported by clear and unequivocal Staff Governance Standards.

Working in partnership with NHS Boards, our Professional Careers Programme provides a 2 year supported employment opportunity for disabled graduates which will equip them with the skills for a long-term career in healthcare. Additionally, through our Disability Delivery Plan, A Fairer Scotland for Disabled People, we are actively working with Health Boards to implement a Learning Disability Employment Programme.

NHSScotland Workforce Statistics, as at 31 March 2017, show that 0.8% of respondents have self-declared as living with a disability. It is not known how many respondents declined to answer. Further information is available at the linked table: https://www.isdscotland.org/Health-Topics/Workforce/Publications/2017-06-06/Equality_and_Diversity_M2017.xls

The Scottish Government and NHS Scotland are taking action to reduce apparent under-reporting where employees are living with a disability. Work is on-going to ensure that all staff working for NHS Boards across Scotland feel comfortable and supported to share their experiences, both through staff surveys and iMatter, a Staff Experience Continuous Improvement Model being rolled out across NHS Scotland.

Information from Scotland’s 2011 census indicates that approximately 20% of people in Scotland are living with a long-term activity-limiting health problem or disability.