National Advisory Committee for Stroke minutes: September 2021

Attendees and apologies

• Prof Martin Dennis (MD)
• Kylie Barclay (KBa)
• Elizabeth Barrie (EB)
• Mark Barber (MB)
• Alan Cowie (ACo)
• Katrina Brennan (KB)
• Jesse Dawson (JD)
• Andrew Farrar (AF)
• Jackie Hamilton (JH)
• Douglas Horn (DH)
• Jacques Kerr (JK)
• Prof Peter Langhorne (PL)
• Therese Lebedis (TL)
• Neil Muir (NM)
• Susan Wallace (SW)
• John Watson (JW)
• Fiona Wright (FW)
• Andy Wilson (AW)
• John Wilson (JW)

Items and actions

Welcome

The Chair welcomed everyone to the virtual NACS meeting, particularly Douglas Horn and Andy Wilson as Co-Chairs of the National Stroke Voices group who were attending their first meeting and would provide an update at agenda item 5. Attendees introduced themselves.

Apologies were noted for Sheena Borthwick, Katie Gallagher, Angela Moar, and Terry Quinn

The Chair reported that before formally retiring and resigning from the group, Mark Smith had informally approached Gillian Crichton, NHS Tayside as the AHP Forum physiotherapy representative. Gillian had indicated a willingness to join, supported by the Scottish Stroke AHP Forum. It was agreed on this basis that a letter of invitation be drafted and sent Gillian to propose her membership of the NACS.

Action 1 – Draft and issue invitation letter to Gillian Crichton, proposing membership of NACS as the Scottish Stroke AHP Forum physiotherapy representative – Secretariat

Minutes of previous meeting (29/03/2021) – NACS/March2021/minutes

Committee accepted the minutes.

Action point update from previous meeting (29/03/21) – NACS March2021/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 – Karen Garrott, Allan Cowie - Arrange presentation/discussion agenda slots on the PfG draft document for the NSV panel beyond the next meeting – The Chair confirmed this had been done.

Action 2 – All - Forward comments/suggestions on the draft PfG document to Prof Dennis by 12 April – The Chair thanked everyone for the comments received.

Action 3 – Karen Garrott, Allan Cowie - Progress an invitation for NSV representation at the September meeting of the NACS once a Chair and Deputy for the NSV have been confirmed – The Chair confirmed that the two NSV Chairs would update at item 5 on the agenda.

Stroke Programme for Government (PfG): progressive stroke services draft

KBa reported that following the last meeting of the group, progress was being made and a draft would be shared with the group and the NSV for comment in October.

Action 2 – Share progressive stroke services draft with the group for comment – Kylie Barclay

Thrombectomy

KB updated the group on developments. It was expected that the service in NHS Tayside would begin accepting patients from the Aberdeen area from the following week. A pilot service in the east of Scotland had begun on 6 September. The west of Scotland were appointing staff following submission of funding bids. A hub and spoke model was being adopted, where each hub centre would have spoke hospitals feeding into them. Plans for artificial intelligence (AI) to support CTA scanning was progressing with national procurement plans in place. The ambulance service had been primed for the hub and spoke model working.

There was discussion on readiness and training and Andrew Farrall updated the group on the use of AI in imaging to highlight abnormalities and work to progress a suitable implementation for Scotland.

Tailored Talks roll-out

The Chair presented on work to develop the Tailored Talks patient information programme, initially to support thrombectomy and also wider stroke care. The aim is to support shared decision making, understanding and consent, structured for patients and relatives. The Chair highlighted how traditional formats for providing information could be lengthy and or inaccessible. Tailored Talks provides bullet points and pictograms to show information for individual patients in real time or before or after a consultation. Patients and carers can be signposted to other resources and the system can capture their feedback on both the content shared and the Tailored Talks platform. Potential benefits included improved involvement, treatment choice and improved outcomes.

Invitations to use Tailored Talks had begun to be sent out in April with a view to encouraging uptake aligned with a Realistic Medicine ethos. To raise awareness and adoption, a series of talks and sessions were scheduled to take place across the stroke community from the autumn.

The group discussed the involvement of the NSV and the potential for coproduction of content and the importance of consistency of messaging and integration into care. MD confirmed he would provide an update at the next meeting.

Action 3 – Provide update on roll-out of Tailored Talks – Prof Dennis

National Stroke Voices (NSV)

DH and AW, as stroke survivors introduced themselves to NACS and highlighted their roles as Co-Chairs of the NSV, giving a voice to the group’s lived experience of stroke. DH set out the initial steps to establish the NSV and the first meetings of the group. DH reported that building synergy within the group with a wide age range, backgrounds and locations had been part of the process of moving the group forward and reported on the collective knowledge of stroke survivors in the NSV. A commonalty reported was fatigue, weakness and disability.

AW updated on the key meetings held which had focussed on pre-hospital care, acute care and rehabilitation. Communication was highlighted as a key issue between clinicians and patients and engagement with the survivor’s voice. The next meeting would look at the future of the NSV. Looking ahead, a form of community outreach for the NSV was touched on with the group providing a collective voice for the PfG programme and implementation plans. The NSV’s role was summarised as a critical best friend to give feedback on implementation.

Scottish Stroke Care Audit (SSCA)

NM confirmed the publication of the Scottish Stroke Care Improvement Plan report on the 29 June and asked if anyone had any questions to please contact him. The SSCA National Meeting had taken place on 2 September and was scheduled for 25 August in 2022. The annual Health Board review process was due for completion by the end of the year. Data collection for thrombectomy had started in Lothian. There was discussion on the use of the online database tool REDcap for data capture. Work to review the outpatient dataset was continuing. MB confirmed Lanarkshire were looking at the use of Datatrak database to manage outpatient data. MB confirmed that the NSV Co-Chairs would be welcome at the SSCA Steering Group meetings.

Scottish Stroke Improvement Plan (SIP)

KB reported that improvement and PfG work were progressing with a view that PfG workstreams would inform a refreshed SIP. Current Boards reviews would use the established Red, Amber Green (RAG) assessment and then would be reviewed in light of PfG work developments.

Review of rehabilitation services

TL updated the group on the review of services the Rehabilitation Subgroup was engaged with as part of a rehabilitation service with improved auditability. Networks had been brought together to provide information on provision and audit. While many services had carried on throughout the pandemic, Covid-19 had produced uncertainties. TL thanked the DH, AW and NM for their support. Variability and a lack of equity were reported. The PfG work would look at what was in place. The Sub-Group had also looked at what services should be, what foundations should be in place including key drivers and the service pathway to adopt to support consistency.

Professional groups - update

EB talked on the update paper provided for the Scottish Stroke Nurses Forum (SSNF). The Forum had last met on 12 August and the AGM had been held the previous week. A new newsletter would be published this week. The Forum presented a Link and Learn session at the end of August. Work had continued on updating STARs modules.

JH drew the group’s attention to the update paper on the Scottish Stroke Psychology Forum (SSPF) circulated to the group. The National Model of Psychological Care in Stroke services and RAG chart will be introduced as part of the annual review process next year. Discussions had started with NM regarding ways to gather reliable data in relation to evaluating psychological care and provision in stroke services. Psychology representation on the Rehabilitation Subgroup continued. Work to input into the relevant STARS modules was ongoing. A new workstream has commenced with the main aim of developing a more standardised approach to teaching around psychological care post stroke. Links have been made with our CHSS colleagues and it was agreed there may be scope to link with NSV in the future. Dr Rachel Pickles, NHS Fife would act as Deputy on the NACS while Dr Roach was on maternity leave.

JD reported on the Stroke Research Network. Despite the impact of Covid-19, work was progressing well with two large drug studies ongoing. Enrolment in Tayside had increased with good engagement. A number of regional meetings had taken place. JD noted that support for people being repatriated across health boards could be looked at. While there had been a reduction in the number of studies due to Covid-19, a good progression of work was reported.

UK guidelines development

The Chair updated on developments regarding the 2016 Royal College of Physician’s National Clinical Guideline for Stroke. Funding had been identified by the Stroke Association to support a review. Health Improvement Scotland were involved and would be leading components of support going forward. It was anticipated that publication would take place in 2023.

Any other business

The group raised no other business.

Next meeting

• NACS September 2021/action 1 - Draft and issue invitation letter to Gillian Crichton, proposing membership of NACS as the Scottish Stroke AHP Forum physiotherapy representative - Secretariat
• NACS September 2021/action 2 - Share progressive stroke services draft with the group for comment - Kylie Barclay
• NACS September 2021/action 3 - Provide update on roll-out of Tailored Talks - Prof Dennis
• NACS September 2021/action 4 - Schedule the next meeting of the group for spring 2022 - Secretariat