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The Scottish Intercollegiate Guidelines Network (SIGN) guidelines on stroke have been withdrawn due to being over 10 years old. SIGN therefore recommend that healthcare professionals look to other up-to-date evidence-based guidelines to inform practice. A good source is the National Institute of Health and Care Excellence (NICE) evidence search that includes trusted sources from a wide range of organisations: https://www.evidence.nhs.uk/

It has been agreed that a four nations approach will be taken to update the Royal College of Physicians Guidelines for Stroke (2016). SIGN is involved in the development process so that the revised guideline will be a collaborative national guideline which will be applicable for use in Scotland.

The Scottish Cardiac Audit Programme, within Public Health Scotland, have been actively seeking data submissions from all sites across Scotland that previously contributed to the UK National Cardiac Audit Programme, managed by the National Institute for Cardiovascular Outcomes Research (NICOR). This includes sites which carry out TAVI procedures.

Scottish participation in the UK National Cardiac Audit Programme (NCAP), managed by the National Institute for Cardiovascular Outcomes Research (NICOR), was previously enabled through the Healthcare Quality Improvement Partnership (HQIP).

The Scottish Government had been working with HQIP since November 2018 to identify a mutually agreeable legal basis that would support Scotland’s continued participation in a number of UK wide audits, including the NCAP programme. It was not possible to identify one and as a result, throughout 2020/21 there was a phased withdrawal of Scottish Government participation in HQIP associated audits as an appropriate point was reached in each.

As replacement for the NCAP, in April 2021 we commissioned Public Health Scotland (PHS) to develop the Scottish Cardiac Audit Programme. PHS have been actively seeking data submissions from all sites across Scotland which previously contributed to the NCAP.

PHS are currently working with clinicians and patients across Scotland to undertake further development of the audit programme.

The Scottish Stroke Care Audit (SSCA) already measures quality of care of Stroke Services in Scotland against the Scottish Stroke Care Standards. Health Boards are provided with reports on a monthly basis. Performance is monitored locally and nationally and actions agreed to improve delivery of stroke care in Scotland. The most recent annual report can be found here: Scottish stroke improvement programme 2021 national report - Scottish stroke improvement programme - Publications - Public Health Scotland

This is similar to the aims of the Sentinel Stroke National Audit Programme (SSNAP) which measures the quality and organisation of stroke care in the NHS across England, Wales, and Northern Ireland.

All 14 NHS Boards have hospitals providing acute stroke care. A map showing all hospitals that contribute data on stroke unit admission to the Scottish Stroke Care Audit can be found in the Scottish Stroke Improvement Programme report at: https://www.strokeaudit.scot.nhs.uk/index.html . Of those sites shown on the map, Stracathro, Stobhill, Vale of Leven, Queen Margaret, Falkirk Community Hospital and Stirling Community Hospital are shown because they contributed data solely on stroke rehabilitation.

The remaining hospitals provide acute beds for stroke patients, either in a unit which has solely acute beds with offsite stroke rehabilitation units for ongoing care, within an integrated stroke unit (combining acute and rehabilitation beds) or in a hyperacute unit. The seven smallest general hospitals define stroke unit admission as gaining access to the appropriate acute medical ward.

Further to the answer given to question S6W-04701, I can confirm that one of the seven clinicians who undertook the peer review was an experienced Haematology consultant who has expertise in the care of haematological malignancies and the associated protocols.

The current Scottish Stroke Care Standards are available at the following link ( https://www.strokeaudit.scot.nhs.uk/index.html)x . At present, they largely relate to acute stroke care.

However, the Scottish Stroke Improvement Programme also includes performance targets which reflect access to rehabilitation in inpatient settings, intensity of provision in stroke units and access to stroke specialist Early Supported Discharge and community teams. The Rehabilitation Sub-Group of the Stroke National Advisory Committee is currently considering future updates to measure rehabilitation service delivery, patient outcomes and experiences within the Scottish Stroke Improvement Programme report.

The Scottish Stroke Care Standards can be found here: ( https://www.strokeaudit.scot.nhs.uk/index.html ). The current standard relating to brain imaging already sets out that 90% of patients should receive this within 12 hours of arrival at first hospital, unless there is a documented contraindication.

The Scottish Stroke Care Standards are regularly reviewed in line with current evidence and updated guidelines. We monitor the implementation of these standards through the Scottish Stroke Care Audit to ensure that stroke patients in Scotland are receiving high quality care.

Further to the answer to question S6W-04701 I can confirm that the case review was undertaken by a small number of NHS Lothian clinicians who are all suitably qualified and experienced in their relevant fields. As none of the clinicians who undertook the review had previously looked after Mr Slorance there was no conflict of interest in undertaking the review.

The Heart Disease Action Plan 2021, sets out a strategic vision to address the impact of heart disease across Scotland. This means that the plan does not provide detailed information on specific conditions but instead identifies four priority areas. These are 1) tackling risk factors, 2) ensuring timely and equitable access to diagnosis, treatment and care, 3) addressing key issues within the cardiac workforce, and 4) ensuring effective use of data to support improvement.

The actions within these priority areas should impact across a number of cardiac conditions and therefore improve services for everyone with heart disease, including for people living with heart valve disease.