A newly published audit on stroke services in Scotland shows that no health board was able to meet the Scottish Government target of giving “appropriate care” to 80 per cent of stroke patients.

Overall, only 68 per cent of patients received an “appropriate care bundle” (stroke unit admission, swallow screen, brain scan and aspirin) in 2018 – a slight improvement on the 65% registered in 2017.

But only Ayrshire and Arran came close to the 80 per cent target, with Highland (48 per cent) and Dumfries and Galloway (63 per cent) among the worst performing boards.

The Scottish Stroke Improvement Programme 2019 Annual National Report includes data from the Scottish Stroke Care Audit (SSCA). During 2018, 9,641 stroke patients were admitted to Scottish hospitals, with an additional 1,085 seen at neurovascular (TIA) clinics.

The number of patients receiving thrombolysis was 1,033 in 2018, similar to the number in 2017 (1,056).

Of these patients, 60 per cent were thrombolysed within one hour of arrival at hospital, a similar rate to the rest of the UK (61 per cent).

Two hospitals exceeded the standard of 80% thrombolysed within one hour of arrival at hospital in 2018.

The data is used by the Scottish Government to monitor progress against the Scottish Stroke Care Standards (2016) and the Scottish Stroke Improvement Plan (2014). Health Boards are expected to identify aspects of their stroke services which do not meet the Scottish Standards and to work with their stroke MCNs to improve their standards of care locally.

Andrea Cail, director of the Stroke Association in Scotland said of the findings: “To dramatically improve the stroke bundle standard target, we believe changes are needed to the way acute stroke services are delivered in Scotland.

“Whilst the planning of a thrombectomy service is providing a catalyst for much wider system change and improvement, the complexity of this work is not leading to the rapid change that is now required.

“The report acknowledges that we have no comprehensive stroke centres in Scotland. But the evidence shows that re-shaping stroke services and creating hyper-acute stroke units (HASUs) with the best equipment and experts in one place can save lives, reduce disability and result in greater cost effectiveness for our health and social care services.

“The SSCA report states that our thrombolysis door to needle times have ‘stalled’, this means there are still people who would benefit from thrombolysis not getting timely access. We know in some areas this is because of the transfer times between hospitals, which could be negated.

“We therefore welcome and support the recent announcement of NHS Tayside’s plans to move to a hyper acute stroke care model – the first NHS Board in Scotland to do so. NHS Tayside has taken their decision based on the clear evidence of improved outcomes for patients. Their new model of care will see all acute stroke admissions on a single site with patients stepped down to their local acute stroke unit for ongoing care at around 48-72 hours.”