National Advisory Committee for Stroke minutes: November 2020

Attendees and apologies

Attendees

• Prof Martin Dennis (MD)
• Kyle Barclay (KBa)
• Elizabeth Barrie (EB)
• Mark Barber (MB)
• Sheena Borthwick (SB)
• Andrea Cail (AC)
• Alan Cowie (ACo)
• Katrina Brennan (KB)
• Jackie Hamilton (JH)
• Craig Henderson (CH)
• Prof Peter Langhorne (PL)
• Therese Lebedis (TL)
• Neil Muir (NM)
• Mark Smith (MS)
• Susan Wallace (SW)
• Fiona Wright (FW)
• John Wilson (JW)

Apologies

• Jesse Dawson
• Neil Muir

Items and actions

1. Welcome

The Chair welcomed everyone to the virtual NACS meeting, particularly Kylie Barclay, who has recently started her role as Senior Policy Manager for Heart Disease and Stroke, Scottish Government.

Minutes of previous meeting (28/05/2020) – NACS/May2020/Minutes

Committee accepted the minutes.

Action point update from previous meeting (28/05/20) – NACS November2020/Action Summary

MD talked through the actions in the circulated Action Point update paper noting those cleared and asked for updates on those ongoing;

Action 1 – All - Forward nominations for a NACS Sub-Group membership to Prof Dennis and Katrina Brennan. MD confirmed that an update on membership and ToR of the group and its 3 subgroups was on the agenda for discussion at item 2.

Action 2 – Andrea Cail / Allan Cowie - Develop a combined plan for patient / carer voices within a refreshed membership structure for the next NACS meeting. MD confirmed that AC and ACo would provide an update for the group on progress at agenda item 6: Patient Public Involvement in PfG.

Action 3 – Secretariat - Draft a new ToR for the NACS and the subgroups. MD informed the group that the finalised ToRs for the NACS and the Sub-Groups had been circulated and were circulated to the group on 9 October for information.

Action 4 – Secretariat - Circulate details on women’s health commitment in PfG. MD noted that an update from the Women’s Health Team as part of a wider health commitment in the 2019 Programme for Government (PfG) had been circulated with agenda and papers for today’s meeting for information. A Women’s Health Group and five sub-groups have been established to develop actions and recommendations. The groups were working to identify gaps in the provision of services, consider areas of best practice, and develop practical actions to address these gaps. An initial set of draft recommendations were expected to be presented to Ministers in December 2020.

Action 5 – Secretariat and Katrina Brennan. Scope funding options to support rehabilitation workshop. MD noted that this action would be put on hold until face to face workshops became a possibility and would come under the work of the Rehabilitation Sub-Group.

Action 6 – Neil Muir. Scope potential for rehabilitation work linkage to SPIRE. MD informed the group that at the last meeting of NACS, Neil indicated he had yet to hear back from SPIRE analysts. Currently, SPIRE was unlikely provide linkage opportunities, although developments could be looked at in future.

Action 7 - Craig Henderson and Katrina Brennan - Liaise regarding fitness of purpose of the Boehringer Ingelheim pre-hospital training course. MD confirmed that at the last meeting for the group, this Action had stalled due to COVID19 activity in SAS. Subsequently, the SAS Medical Director has approved this course and was now live for all operational crews to access.

2. Membership and Terms of Reference (ToR) of the groups

MD noted that the Secretariat had circulated the finalised drafts of the ToRs of the NACS and the subgroups in October. Membership of the subgroups had been progressed with new members identified and invitations sent. An initial timetable of meetings had been put in place. MD touched on the need to include medical trainees to link to the work being taken forward on the PfG agenda. The Chairs of the Sub-Groups agreed to forward on a list of the up to date memberships to Secretariat.

Action 1 – Forward NACS Sub-Group memberships to secretariat – Neil Muir, Therese Lebedis, Fiona Wright

3. Scottish Stroke Care Audit (SSCA)

MB updated the group. This year’s report had been delayed until 1 September due to the impact of COVID19 and featured an interactive component. MB highlighted that feedback on this year’s report would be welcomed. The monthly reports have been reviewed. Steps to make use of the Redcap data tool were being progressed. MB confirmed that the home time component of the report would looked at for future reporting. The next SSCA steering group was scheduled for the 24th November.

4. Scottish Stroke Improvement Plan

KB reported that Health Board reviews had been completed with a focus on the Programme for Government (PfG) components with specific pieces of work being scoped by Boards. Common themes were to be collated in line with the PfG. The MCN Subgroup were progressing improvement plan priorities 7 & 8 under the PfG commitments.

5. Stroke PfG discussion and update

The Chairs of the three Subgroups set out that the groups would report to NACS and focus on specific areas with the SSCA Subgroup examining performance at each Health Board, the MCN Subgroup looking to the future and progressive stroke services and the Rehabilitation Subgroup focussing on care in hospital, the community, long term support and what a progressive stroke rehabilitation service would look like.

There was discussion on work to identify contributions to inform work on a progressive stroke service including a suite of three reviews on rehabilitation and service in low, medium and high income countries. MD noted that the work of the Subgroups would draw on best evidence and practice to drive improvement across the whole patient pathway.

6. Patient Public Involvement in PfG

ACo informed the group that PfG improvement work to include service users and patients had been progressed since the last meeting. A proposal had been drafted and submitted to the PfG Executive Group to establish a National Panel of Stroke Voices to include eight to ten people who had experienced a stroke in the last six years. Their role would be to act as a conduit and amplifier around pathways and as a mechanism for quality improvement and support for PfG commitments.

The group were supportive of the proposal and to advertise and recruit to the panel with a view to going live in the spring of 2021. AC noted that work would be done to include MCN patient groups in these plans. AC confirmed that the advert to join the panel would also go out to the NACS membership and Subgroups. TL confirmed that she would align the proposals to the work of the Rehabilitation Subgroup.

The delivery of this work will be jointly facilitated and administered by the Stroke Association and Chest Heart and Stroke Scotland with oversight provided by NACS.

7. Thrombectomy

MD updated the group on imaging work on CT angiography with an options appraisal progressed. Options were also being scoped on artificial intelligence systems for CT angiography to assess patient suitability. Nurse training was ongoing in advance of centres being active in terms of STAT and STAT+ with online training also in place. A new STARS module had been launched in July.

KB updated on regional services. A significant volume of work across a number of fronts was reported. A start for the North of Scotland pilot in NHS Tayside had been scheduled for 9 November. In the west of Scotland, funding had been approved for project management and a meeting with managers had been arranged to discuss further. In the east, progress was being made with a focus from managers and Chief Executive. Work was progressing with regional planning teams around the hub and spoke hospitals approach.

CH informed the group that the Scottish Ambulance Service (SAS) was continuing to support NHS Tayside ahead of the start of the North of Scotland pilot. A new member of the team at the SAS looking at strokes had been appointed. A professional to professional platform was touched on and CH confirmed that linking with colleagues through the model established through the trauma network was taking place and that there was recognition that any progress would be shared.

8. AOB

MD informed the group of an item of additional business and Jacki Hamilton talked on the Scottish Stroke Psychology Forum (SSPF) update paper, previously circulated to the group. The paper covered a number of items including a recommended model of psychological care in stroke services.

MD asked the group if NACS members could provide updates on the groups they represent such as the Scottish Stroke Nurse Forum (SSNF) and the Scottish Stroke AHP (SSAHP) Forum at meetings going forward and also to nominate a deputy in their absence.

Action 2 – Provide updates for NACS on professional groups going forward: SSNF, SSAHP, Forum SSPF, and Stroke Research Network – NACS professional group representatives

Action 3 – Nominate a deputy to secretariat – NACS professional group representatives

The group raised no other business.

9. Next meeting

Secretariat agreed to confirm dates in 2021 with the group.

Action 4 – Confirm NACS meeting dates for 2021 – Secretariat

Action reference	Description	Responsibility
NACS November 2020/Action 1	Forward NACS Sub-Group membership to secretariat	Neil Muir, Therese Lebedis, Fiona Wright
NACS November 2020/Action 2	Provide updates for NACS on professional groups going forward: SSNF, SSAHP Forum, SSPF, Stroke Research Network	NACS professional group representatives
NACS November 2020/Action 3	Nominate a deputy to secretariat	NACS professional group representatives
NACS November 2020/Action 4	Confirm NACS meeting dates for 2021	Secretariat