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Coronary Heart Disease and Stroke: STRATEGY FOR SCOTLAND
MINISTERIAL FOREWORD
From their peak incidence in the 1970s, rates of Coronary Heart Disease (CHD) and stroke have steadily declined in Scotland, as in other industrialised countries. We are making progress, but not at as fast a rate as other countries, for example our north European neighbours. CHD and stroke will remain a major concern for many decades to come. The reasons for this go beyond the traditional risk factors of age, male gender, family history, smoking, diet, high blood pressure and lack of physical activity. As our Social Justice agenda shows, there has been a growing awareness of the important effect childhood influences and socio-economic inequalities also have on adult health.
As treatments improve, so the number of survivors of a heart attack or a stroke increases. In addition, our population is ageing, and with that changing demography, more people will develop symptoms of CHD and stroke in later life. As the Chief Medical Officer's report on the healthcare of older people,
Adding Life to Years pointed out, we must begin planning now to make sure that services are able to respond. This Strategy is an essential part of that planning.
The Executive is committed to primary prevention, the prevention of the onset of symptomatic disease. CHD and stroke have been recognised as a national clinical priority because of the extent to which the illness and death associated with them can be prevented. We are committed to the prevention as well as the treatment of CHD and stroke. As the First Minister made clear recently, we will meet the challenge of changing people's attitudes to health, including diet and physical activity, fully aware that it could take a generation for the results to show. The national demonstration project 'Have a Heart Paisley' is yielding valuable lessons about the prevention of CHD in a community which is in itself a microcosm of Scotland. Our recently expanded Health Improvement Programme is aimed at creating a cross-Executive approach to risk factors such as lifestyle and life circumstances. The Social Justice programme is addressing the wider social, economic and environmental causes of health inequalities. We must root out the fatalism about health expectations which is one of the worst legacies of deprivation.
Another imperative is to focus on high-quality treatment. That means not just making sure people get the treatment they need. It means embracing new treatments as they become available, constantly improving quality of services, and above all treating people earlier, given the clear evidence of the benefits of doing so. That's why we announced new, shorter waiting times targets for CHD earlier this year. For those who have had a stroke, we must make sure as many as possible are cared for in a specialist stroke unit. We must also manage those who have already had a heart attack or stroke so as to reduce their risk of suffering another. This process of secondary prevention has also been an important part of 'Have a Heart Paisley'.
Managed Clinical Networks for stroke and cardiac services are the mechanism for delivering all of this. They integrate the full spectrum of services from primary prevention to rehabilitation. They put patients' interests at the heart of service design. They fully involve patients, the voluntary sector and clinicians in the planning of services. They encourage new ways of working in multi-disciplinary teams, and therefore allow staff to explore new roles so that services can be improved. They are based on information systems that span traditional organisational barriers, particularly between primary and secondary care. MCNs are an essential part of our commitment to developing services that meet the needs of the users rather than the deliverers. Services that are based in the community, where 90% of the contact with the NHS takes place.
A further key priority is the development of national databases for CHD and stroke. This is part of our commitment to providing the public with meaningful information about services, so they can take control of their own health and act as equal partners in discussions about their healthcare. These databases are also essential to the rational planning of services, and to the process of constant improvement in quality. They are vital if we are to be able to review the clinical standards for CHD and stroke, and to extend both sets of standards to primary care.
The Strategy represents the culmination of 4 years' work. The CHD/Stroke Task Force spent 3 years drawing up its report, based on extensive consultation with patients, clinicians and managers. It was given a very positive response, and over the last year the Reference Group has been able to build on the consensus contained in that report. I want to thank the members of the Task Force and the Reference Group for the commitment and hard work they have given so unstintingly to the development of this Strategy.
I have accepted the recommendations for the national advisory structures which should be set up for CHD and stroke, which now need to develop in distinctive ways. To take this work forward, I am appointing Professor Martin Dennis to chair the new National Advisory Committee on Stroke. I am also appointing Dr Nick Boon to act as Project Manager of the CHD Project Group which will draw up the development plan for the Scottish Cardiac Intervention Network. During this transitional phase, the CHD Project Group will act as the Department's source of advice on CHD matters, and will be constituted so that all interests are represented.
The Executive will provide substantial additional investment to support this renewed commitment to tackling CHD and stroke. That investment will be targeted at the priorities I have mentioned: developing the national databases and helping to establish the range of Managed Clinical Networks set out in the Strategy. We will monitor the results closely through the advisory bodies for CHD and stroke, and through the revised Performance Assessment Framework. There should be no room for doubt about our determination to reduce the unacceptable toll which CHD and stroke take on Scottish families and communities. This strategy should make a significant contribution to achieving that goal.
Malcolm Chisholm, MSP
Minister for Health and Community Care
Scottish Executive Health Department
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