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The Scottish Government welcomes the work of the European Stroke Organisation and agree that it is vital to ensure improvements are made to stroke pathways and services, including prevention, treatment and care.

Through our Programme for Government commitments and the Stroke Improvement Plan, we are already reflecting the aims of the European Stroke Organisation’s appeal targets.

We are supporting the National Advisory Committee on Stroke to develop a progressive stroke pathway document which will set out the vision of what stroke services across Scotland should deliver across the whole patient pathway, including access to stroke rehabilitation, and access to support for people who have experienced a stroke. However, at this time, the Scottish Government does not have plans to use the tracker. The Scottish Stroke Care Audit will continue to track our progress against the Scottish stroke care standards.

The Scottish Stroke Improvement Team have reported on a 12 hour Standard for brain imaging since the Scottish Stroke Improvement Programme National Report (2020). Prior to this, the standard had been within 24 hours. This change in Stroke Standard was in response to a change in the evidence base, with some new treatment regimes being shown to improve outcome when initiated within 12 hours of stroke onset.

Some cases of stroke are time critical emergencies and should be scanned immediately, for instance those patients requiring hyperacute interventions such as thrombolysis and thrombectomy. These specific cases have their own stroke standards on door-to-needle times which ensure that processes are audited and service improvement packages are put in place.

The numbers of confirmed strokes admitted during 2016 - 2021 showing median time (minutes) to brain imaging are shown in the following table:

The Scottish Government is committed to ensuring that all children and young people are able to access the right support for their mental health without stigma, including medication where this is the most appropriate intervention.

The Scottish Government does not hold data on the numbers of children and young people who have been offered talking therapy or who have refused talking therapy as a treatment option.

Prescribing is a clinical decision based on a prescriber’s judgment as to what they believe to be in the best interests of the patient. The prescribing of antidepressants to children and young people is undertaken in consultation with the patient and, where appropriate, with their family, to ensure that patient choice is also central to decisions taken regarding treatment and care.

Medication is one aspect of treatment, alongside psychological therapy or other therapeutic interventions, available as an option for children and young people who require support. We continue to invest and improve access to other services, including by providing £16 million per annum to ensure that every secondary school in Scotland has access to counselling support; and by investing £15 million in community-based mental health and wellbeing services as part of our focus on early intervention and prevention.

There is evidence that access to a stroke unit improves outcome for stroke patients.

The Scottish Stroke Care Audit (SSCA) monitors the quality of care provided by the hospitals in all NHS Boards and access to a stroke unit is a standard measured by SSCA, alongside other standards associated with improved patient outcomes. Performance against the standards, and more detail on service models can be found here:

Scottish stroke improvement programme 2021 national report - Scottish stroke improvement programme - Publications - Public Health Scotland .

I refer the member to the answer to question S6W-05487 on 21 January 2022. All answers to written Parliamentary Questions are available on the Parliament's website, the search facility for which can be found at https://www.parliament.scot/chamber-and-committees/written-questions-and-answers

Guidelines are intended as an aid to clinical judgement, not to replace it. The ultimate decision about a particular clinical procedure or treatment will always depend on each individual patient’s condition, circumstances and wishes, and the clinical judgement of the healthcare team.

Scottish Intercollegiate Guidelines Network (SIGN) have taken the opportunity to take a four nations approach and collaborate with the Intercollegiate Stroke Working Party on the 6th edition of the Royal College of Physicians National Clinical Guideline for Stroke which is expected to be published in February 2023. This will be a collaborative national guideline which will be applicable for use in Scotland.

There are a wide range of definitions for Stroke Units and it is understandable that stroke units will look very different between, for instance, a large city hospital and island NHS Boards

The core criteria for defining a stroke unit are well described in the academic literature, including in Langhorne et al (2002). Professor Langhorne is a member of the Scottish Stroke Care Audit (SSCA) Team and has been influential in defining different models of stroke unit care.

NHS Boards are expected to describe their stroke unit models through the SSCA processes and the Scottish Stroke Improvement Programme Team review this information during Board Reviews (now occurring at least twice annually). This ensures that optimal and evidence based services are being delivered and demonstrates that stroke units are viewed as a core component of care.

We are supporting the National Advisory Committee on Stroke to develop a progressive stroke pathway document which will set out the vision for what stroke services across Scotland should deliver across the whole patient pathway, including access to stroke rehabilitation, and access to support for people who have experienced a stroke.

Scottish Government will work closely with the Stroke Improvement Programme Team and stakeholders throughout 2022 to develop an implementation plan to deliver the vision set out in this document.

We will continue to take steps to introduce a high quality and clinically safe thrombectomy service in Scotland. A Scotland wide service is expected to be operational by 2023.

Planning of community rehabilitation delivery is the responsibility of individual NHS Boards and Health and Social Care Partnerships.

Our vision is for everyone with rehabilitation needs to be able to access the care and support they need to live well, on their own terms. Exploring ways to improve access to rehabilitation is a key aspect of the work underway to develop a progressive stroke pathway document.

With regard to measuring performance, the provision of appropriate rehabilitation, in both acute and community settings, currently forms part of the Scottish Stroke Improvement Programme (SSIP) criteria-based assessments.

These are currently being reviewed and expanded and will form part of the regular reviews which are undertaken by the Scottish Stroke Improvement Programme team with each Health and Social Care Partnership. We will also consider how these might be integrated into the Scottish Stroke Care Audit if effective.