1.1Better Health, Better Care, the Scottish Government's action plan for health and wellbeing, confirmed that Coronary Heart Disease ( CHD) and stroke together remain national clinical priorities in Scotland and contained a commitment to refreshing the version of the national clinical strategy published in 2004. This Action Plan reflects the direction set out in Better Health, Better Care in the way in which it seeks to respond to a series of challenges:
- listening to what people with, or at risk of, heart disease or who have had a stroke tell us about the kind of services they want;
- responding to developments in the evidence base, as reflected in the suite of SIGN Guidelines on CHD and cardiovascular disease ( CVD) published in February 2007, and the revised stroke Guideline published in December 2008;
- introducing a new focus on prevention of ill health through anticipatory care approaches;
- reducing health inequalities across Scotland;
- meeting the needs of increasing numbers of older people; and
- responding to changes in our workforce.
1.2 This Action Plan responds to these challenges by setting out the ways in which we can prevent CVD, improve people's experience of services, embed services to a greater extent in local communities and ensure that high quality services are planned and delivered efficiently. It responds to the clear evidence of health inequalities in heart disease and stroke in terms of both deprivation and ethnicity and sets out actions to ensure that we better engage with those groups that have often proved to be most challenging to reach, and provide targeted interventions to address preventable heart disease and stroke.
1.3 In producing this Action Plan, we have worked closely with key voluntary sector organisations such as the British Heart Foundation, Chest, Heart & Stroke Scotland and the Stroke Association's Scottish branch, in keeping with the commitment given by the Scottish Government to strengthening its ties with the voluntary sector because of its key role in providing support and services. In line with the principle set out by the Chief Medical Officer in his work on long term conditions, we must learn from the experiences of those who are living with heart disease, or have had a stroke, and their families and unpaid carers. We will work with the voluntary sector to help implement the actions in this Action Plan.
1.4 The Action Plan also takes account of the responses to the consultation document Better Coronary Heart Disease and Stroke Care launched in July 2008, and the outputs from the consultative event held in Glasgow in December 2008, which was attended by 150 people with a personal or a professional interest in these conditions.
1.5 As a result of the consultative process, the Action Plan has been extended beyond the traditional view of CHD, by including heart failure and inherited cardiac conditions. In order to reflect that wider perspective, the Action Plan refers where appropriate to 'heart disease' rather than ' CHD'.
1.6 The Action Plan needs to be set in the context of a range of other policies and strategies, such as:
- the generic work on the management of long term conditions, including Gaun Yersel!, the national strategy for self management of long term conditions produced by the Long Term Conditions Alliance Scotland;
- the Long Term Conditions Action Plan;
- Equally Well;
- inequalities-targeted high-risk primary prevention, 'Keep Well';
- 'Life Begins …' checks;
- Early Lives;
- Better Together;
- Partnership Improvement and Outcomes;
- Healthy Working Lives;
- the Delivery Framework for Adult Rehabilitation;
- the disability strategy and the Scottish Vision Strategy;
- Towards a Mentally Flourishing Scotland;
- the community empowerment plan;
- Living and Dying Well, a National Action Plan for Palliative and End of Life Care in Scotland;
- the National Performance Framework.
1.7 The Scottish Government has set out an ultimate 'Purpose' which unites public services across Scotland and requires them to work in partnership to deliver sustainable economic growth and opportunity for everyone in Scotland to flourish. NHSScotland has a key role in supporting this, particularly through the underpinning requirement to provide services which will enable people in Scotland to live healthier, longer lives. Better Health, Better Care (Scottish Government, 2007) set out the action plan for NHSScotland which is intended to deliver this outcome. Increasingly, this will be focussed on the priority of raising the quality of NHSScotland healthcare services to world-leading levels.
1.8 A new Healthcare Quality Improvement Strategy is being developed to create a clear vision and focus for the range of improvement work already being driven forward across NHSScotland. The proposed approach will support the six dimensions of quality:
providing care that is responsive to individual patient preferences, needs and values and assuring that patient values guide all clinical decisions
avoiding injuries to patients from care that is intended to help them
providing services based on scientific knowledge
avoiding waste, including waste of equipment, supplies, ideas, and energy
providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location or socio-economic status
reducing waits and sometimes harmful delays for both those who receive care and those who give care
Source: Institute of Medicine
1.9 One of the key drivers of healthcare quality is patient-centred services. The Scottish Government is currently pursuing a range of approaches across NHSScotland which will increasingly focus the development and delivery of healthcare services around each individual's preferences and requirements. These approaches include the work in train to develop a 'mutual' NHS. Establishing and communicating patients' rights, expectations and responsibilities is a major strand of this approach. Another strand is the Better Together programme which is gathering evidence on what people in Scotland expect of their NHS. It will then measure people's actual experience of healthcare services, producing information which will in turn inform action to improve services. We will ensure that that work aligns with the actions set out in this Action Plan.