Business and Regulatory Impact Assessment: Stroke Improvement Plan 2023
1. Purpose and Intended Effect
The Stroke Improvement Plan 2023 seeks to build on the previous Stroke Improvement Plan, published in 2014. Since the publication of the 2014 plan, we have made significant progress in many areas of stroke care. The Stroke Improvement Plan considers recommendations made in the Progressive Stroke Pathway, produced by the National Advisory Committee for Stroke.
Over the last decade, the death rate from cerebrovascular disease has decreased by 26%. However, stroke remains a leading cause of death in Scotland. There were 3,836 deaths in Scotland in 2021 where CVD, including stroke, was the underlying cause and we will always strive to do more to deliver the best possible health and social care and to ensure that the issues we are focusing on continue to reflect the current needs of people who need stroke care in Scotland.
In addition, the Covid-19 pandemic has highlighted challenges and changed models of care across the entire health care system and this is an appropriate point to take stock and refresh our actions on stroke.
The vision and priorities of this plan are closely aligned with the vision and principles of the National Clinical Strategy for Scotland, which are; a focus on quality, change guided by evidence, allowing people and communities to manage their own health, new models of community-based provision, equitable access, encouraging collaboration and the implementation of Realistic Medicine.
This plan sets out that we want to minimise preventable strokes and ensure timely and equitable access to life-saving treatment. Additionally, the plan places renewed emphasis on the importance of the provision of holistic care, particularly in the approach to rehabilitation, and ensuring the psychological impacts of stroke are given renewed prominence in stroke care.
1.2 Vision and Priorities
The Stroke Improvement Plan sets out our priorities for stroke care service until 2028.
Vision: We want to support delivery of the best possible stroke care in Scotland. This means considering the entire stroke pathway, from prevention and awareness raising to the provision of rehabilitation and ongoing support.
To achieve this vision, the plan identifies seven priority areas
Priority 1: Prevention
We will seek to prevent as many strokes as possible, by working to improve the detection and management of underlying risk factors for stroke.
Priority 2: Awareness raising
We will work to understand current public awareness of stroke symptoms, and the action required when they occur, and support the delivery of FAST campaigns.
Priority 3: Hyperacute care
We will optimise delivery of thrombolysis and expand access to the national thrombectomy service, with the aim of a national round-the-clock thrombectomy service.
Priority 4: Early secondary prevention
We will seek to prevent as many additional strokes as possible by optimising the care of those who have suffered a stroke or TIA.
Priority 5: Rehabilitation
We will make the provision of high quality, holistic rehabilitation a cornerstone of stroke care in Scotland. Rehabilitation should be person-centred, re-accessible, delivered in the appropriate setting and patient outcomes and experiences measured.
Priority 6: Psychological care
We will ensure that the emotional and cognitive needs of those who have survived a stroke are given the same level of importance as their physical needs and recovery.
Priority 7: Collaborative implementation
We will establish a Scottish Government led forum for bringing representatives of every NHS Board stroke service, as well as third sector organisations, together. This will facilitate the sharing of best practice and identify opportunities for collaborative care across NHS Boards.
We have identified 20 commitments across all seven priority areas. Flagship comitments include:
- Work with the three thrombectomy hub regions (North, East, West) to maximise access to thrombectomy, driving expansion of hours of service and geographical access with the aim of a national round-the-clock thrombectomy service.
- Publish a detailed plan for further development of the national thrombectomy service, with a focus on increasing equity of access across all regions, in the second half of 2023.
- Scottish Government will establish a regular engagement forum, represented by stroke services from every NHS Board and third sector organisations, to drive improvement work and identify opportunities for collaborative care.
- NHS Boards will be required to evidence appropriate pathways for patient-led direct re-access to stroke rehabilitation and offer a review to everyone who has suffered a stroke, six months after their stroke.
2.1 Within Government
We have engaged internally with other policy teams. Included in these discussions were:
- Mental Health
- Health Finance
- Openness & Learning
- Person-centeredness and participation
- Workforce planning
- Modernising Patient Pathway
- Recovery and rehabilitation
- Health Literacy
- Older People and Palliative Care
2.2 Public Consultation
There will not be a formal public consultation on the Stroke Improvement Plan.
The decision to not conduct a public consultation was based on the fact that this is an operational plan for the next five years rather than a long-term strategy. The aim is to continue to recover from the impact of COVID-19 on stroke services and to build on work already developed such as progress with a thrombectomy service across Scotland. As such there is a need to develop this plan at pace.
The plan was developed in collaboration with Professor Martin Dennis (who, until 31 March was CMO Specialty Advisor on Stroke and Chair, National Advisory Committee of Stroke), Katrina Brennan (National Coordinator, Stroke Improvement Plan) and third sector partners such as the Stroke Association and Chest Heart & Stroke Scotland.
The National Advisory Committee on Stroke were involved in discussions about the refresh of the Stroke Improvement Plan (2014) and were consulted on the draft document throughout February / March 2023.
2.3 Business/Third Sector
We have consulted with Stroke Association and Chest, Heart & Stroke Scotland on the development of the Stroke Improvement Plan. The Stroke Association is a charity that has been operating in Scotland since 2007. They support the recovery of stroke survivors by providing information, support and advice. Other key areas of work include funding research, fundraising and volunteering. Chest, Heart & Stroke Scotland is a Scottish health charity which supports people across Scotland, including people who have experienced a stroke. Furthermore, we have engaged with National Stroke Voices to ensure the lived experience of stroke was reflected in the Progressive Stroke Pathway and the Stroke Improvement Plan.
3.1 Sectors and groups affected
The whole adult population, specifically those who engage with services for stroke will be affected. This includes those who have experienced a stroke, those receiving rehabilitation, and those who have stroke risk factors like high blood pressure or high cholesterol. Wider groups affected by the plan include NHS boards, national bodies, and the Third Sector.
3.2 Option 1 – Implement the new Stroke Improvement Plan 2023
The Stroke Improvment Plan 2023 is composed of 20 comitments across seven key priority areas for the delivery of services for people who need stroke care in Scotland. The various actions are to be carried out by health boards, government, and advisory groups. These actions will not be carried out by businesses and the plan does not require any new legislation or regulations.
The plan will see a 'Once for Scotland' approach adopted, where appropriate, to stroke services. This will see the same prioritisation and delivery of services is used across Scotland, helping to ensure we minimise preventable strokes and ensure timely and equitable access to life-saving treatment.
We recognise that to support delivery of the best possible stroke care in Scotland means considering the entire stroke pathway, from prevention, awareness raising and dignosis to the provision of rehabilitation and personalised care and support received after treatment, with the aim of improving both outcomes and experience throughout an individual's journey.
The Stroke Improvment Plan provides a strategic focus to drive forward innovative solutions to the delivery of diagnosis, treatment and care for people who have experienced a stroke. This seeks to reflect our learning from the impact of COVID-19; improve access to diagnosis, treatment and care and minimise inequities in access.
Implementation of the Stroke Improvement Plan will provide a strategic direction to the actions taken to address stroke care over the next five years. It will also enable us to focus our resource strategically to support the best possible improvements to pathways of care which will enable the identification of unwarranted variation and support our ability to tackle inequities in access and outcomes in stroke care. The overall benefit will be that we will minimise preventable strokes and ensuring timely and equitable access to life-saving treatment.
The Stroke Improvement Plan has £0.5m resource funding for 2023/24 and will require further funding in future years. These future costs have not been estimated at the current time.
3.3 Option 2 – Do nothing
Failure to implement the Stroke Improvement Plan would limit the ability for stroke services across Scotland to drive forward with key improvements envisoned. This in turn would prevent redesign of services, and prevent investment in key areas of service that will be most pressured over the coming months, with possible negative impacts on outcomes from stroke.
None. Failure to implement the plan would likey be a catalyst for poorer outcomes from stroke.
Failure to implement the Stroke Improvement Plan would mean that the benefits identified above in relation to option 1 (summary of benefits) would not materialise. There would be no immediate additional costs through this option, but it has the potential to lead to an increase in costs further in the future due to delays in services provided and increased use of hospital services.
4. Scottish Firms Impact Test
The Stroke Improvement Plan should have no impact on the competitiveness of Scottish companies within the UK, or elsewhere in Europe or the rest of the world.
5. Consumer Assessment
The Stroke Improvment Plan aims to improve the accessibility/availability of services for people with stroke in Scotland so will not have a negative impact on consumers.
6. Digital Impact Test
The Stroke Improvement Plan will allow for the adoption of potential new stroke related technologies during its lifetime, but due to the delivery period of this plan, there will likely be no impact on future delivery.
7. Legal Aid Impact Test
The Stroke Improvement Plan is not creating new rights or responsibilities. It is focussed on increasing and improving health care accessibility, so should have no impact on the legal aid fund.
8. Enforcement, Sanctions, and Monitoring
The Stroke Improvement Plan does not propose regulations or legislation therefore enforcement, sanctions and monitoring will not be required. Scottish Government and the National Advisory Committee on Stroke will work with Health Boards to implement the actions in the plan.
9. Implementation and Delivery Plan
The Stroke Improvement Plan will be driven by the Scottish Government Stroke Policy Team and the National Advisory Committee on Stroke, and implemented by NHS Boards and national services. The plan is a refresh of the Stroke Improvement Plan 2014 which the Stroke Policy Team and National Advisory Committee on Stroke implemented and monitored. It will be their responsibility to implement the plan and to make any decisions regarding it. The plan has a proposed five year time frame.
10. Post-Implementation Review
The implementation of the Stroke Improvement Plan will be reviewed at regular intervals throughout its lifecycle by the National Advisory Committee for Stroke.
11. Summary and Recommendation
It is recommended that the Stroke Improvement Plan is implemented as it will support the improvement of diagnosis, treatment and care for people who experienced a stroke and ensure appropriate recovery from the Covid-19 pandemic. It will be monitored by the Stroke Policy Team and the National Advisory Committee for Stroke, and they will provide the Minister for Public Health and Women's Health and the Cabinet Secretary for NHS Recovery, Health and Social Care with regular updates on progress.
12. Declaration and Publication
I have read the Business and Regulatory Impact Assesment and I am satisfied that (a) it represent a fair and reasonable view of the expected costs, benefits and impact of the policy, and (b) that the benefits justify the costs. I am satisfied that business impact has been assessed with the support of businesses in Scotland.
Minister's name: Jenni Minto
Minister's title: Minister for Public Health and Women's Health
Scottish Government Contact point: Clinical_Priorities@gov.scot
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