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There is evidence that achieving the stroke bundle reduces mortality and increases the chance of patients returning to their usual place of residence after stroke.

There are a number of other factors in achieving an acceptable level of care for people with stroke. However, the stroke bundle is a simple metric which has been shown to be associated with improved outcomes. The Scottish Stroke Improvement Programme Team will continue to support NHS Boards to achieve the Stroke Bundle as well as supporting improvements across the stroke pathway.

Information on the location of vaccinations, cross referenced with the recipients health board, is not held centrally.

In response to the pressures on NHS services caused by the pandemic over the past 18 months, the First Minster launched the NHS Recovery Plan, on the 25 August. The Plan sets out the Scottish Governments key headline ambitions and actions to be developed and delivered now and over the next 5 years.

While it is important to stress that recovery is the immediate task, this Plan is fundamentally about ensuring that the process of recovery focusses on alternatives pathways of care that allow people to be treated more quickly closer to home and also delivers long term sustainability. The plan is backed by more than £1 billion of investment over the next five years.

Our Detect Cancer Early (DCE) Programme is aimed at increasing early diagnosis rates of Scotland’s most common cancers while reducing health inequalities. Following an options appraisal exercise, melanoma was selected as the next tumour type for inclusion in the DCE Programme in 2016.

DCE’s website (getcheckedearly.org) and digital channels help to increase awareness of symptoms of a number of tumour groups, including melanoma, on an ongoing basis. The Programme also works closely with third sector to share patient experience stories, to prompt others to take action.

DCE launched a new overarching campaign – Survivors - in September 2018 to reduce fear of cancer and empower people to act early, if they noticed any possible signs of cancer. The NHS Recovery Plan, published 25 August 2021, commits a further £20 million investment to the DCE Programme which will include additional public awareness campaigns.

We continue to work with key partners across Scotland to ensure that relevant information from patient health records is available to healthcare staff when and where they need it. Significant investment in national IT systems, such as those for GP practices and the TrakCare hospital patient management system in secondary care, has improved the flow of information across different healthcare settings and services. In addition, the availability of Regional Clinical Portals, the roll out of HEPMA ( Hospital Electronic Prescribing and Medicines Administration ) and availability of the patient Emergency Care Summary (ECS) to Community Pharmacists, Dentists and Optometrists have all improved the accessibility and quality of electronic patient information available to frontline staff.

Further improvements will be made including the implementation of Office365 across the entire NHS. This will include the rollout of single identities for NHS staff which will simplify secure access to relevant patient information. The refreshed Digital Health & Care Strategy, scheduled to be published in September 2021, will set out ambitions for greater access to medical information both for staff and the public.

The figures provided below include patients waiting to have their initial appointment with a consultant (new outpatient) and patients who were waiting to be admitted for treatment (inpatient or day case) within select specialties relating to the question.

In the field of orthopaedic medicine, trauma is categorised as a severe injury to the elements of the musculoskeletal system (muscles, joints, ligaments, bones, and soft tissue). These trauma injuries are often the result of a sudden accident, such as a fall or car accident, and so the patient requires immediate medical attention. Consequently, no waiting times are provided here.

Table 1 shows the total number of patients waiting for a new outpatient appointment across NHS Scotland at 31 May 2019, 31 May 2020 and 31 May 2021, broken down by specialty. Note that 95 th percentile waits have been provided rather than the longest wait as a more robust measure. This is due to the likelihood of the longest wait for each specialty being a data quality issue as opposed to a true waiting time.

Table 1: Total waiting for a New Outpatient appointment and 95 th percentile waits, 31 May 2019, 31 May 2020, 31 May 2021; NHS Scotland

The Scottish Stroke Care Audit does not currently directly measure level of disability at the time of hospital discharge. The stroke improvement team rehabilitation sub group is currently considering future updates to measure rehabilitation service delivery, patient outcomes and experiences.

Rehabilitation is a person centred process. People with ongoing impairment and activity limitations following a stroke are assessed by a multidisciplinary team and their wishes and needs are agreed individually as part of their rehabilitation plan. All patients who require stroke rehabilitation should be offered it. Rehabilitation may be delivered via a variety of inpatient, early supported discharge and community teams

As of August 23rd there are 8,220 records flagged receiving 2 doses of mixed COVID-19 vaccine products in the National Clinical Data Store (NCDS).

There are 7,697,632 total records ( first and second doses ) in the NCDS relating to COVID-19 vaccinations therefore this number is 0.11% of records flagged.

The circumstances for these are not recorded.

Data completeness and accuracy checks have not yet been carried out on each of these records, therefore some of these records may be duplicates, or in fact relate to more than a single individual.

The core criteria for defining a stroke unit are well described in the academic literature, including in Langhorne et al (2002). Though the size and configuration of stroke units across Scotland may vary depending on local factors, most will be in a defined ward setting and have a specialist stroke multidisciplinary team.

Covid-19 has had an unprecedented impact on the world, NHS Scotland and stroke services. Each service will have responded in the best way that it could, depending on the specific issues affecting them.

The 2021 Scottish Stroke Improvement Programme Report (which includes 9 months of the pandemic) shows slight deterioration in performance against the stroke standards for stroke unit access (77% in 2020 compared to 82% in 2019).

While stroke unit access declined, achievement of standards in other areas, including brain imaging within 12 hours of arrival (86% in 2020 compared 84% in 2019), time to carotid intervention (61%; 59%) and mean thrombolysis door-to-needle (DTN) time (51 minutes in 2020 compared to 53 minutes in 2019), improved.

All of these aspects also have an important impact on recovery from stroke, and therefore it is not possible to isolate the recovery impact based on one standard (such as stroke unit access).

Work is ongoing to produce a progressive stroke pathway document by December 2021. This will take account of international evidence, including the World Stroke Organisation’s roadmap to delivering quality stroke care, to define what a progressive stroke pathway should look like in Scotland.

The progressive stroke pathway will, similarly to the roadmap, follow the continuum of care starting at the onset of a stroke event through the acute phase (emergency department and inpatient care), and stroke rehabilitation and long term supported recovery.

Following this, an implementation plan will identify any gaps between current capacity and the progressive stroke pathway vision, and outline clear actions to take.