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Coronary Heart Disease and Stroke: STRATEGY FOR SCOTLAND

1 The CHD/Stroke Strategy

INTRODUCTION

1. The CHD/Stroke Task Force Report has been well received and from analysis of the responses to the consultation exercise it became clear that there was strong support for the majority of its recommendations. The Reference Group recognises that most of these recommendations can only be implemented if and when additional manpower and financial resources become available. The Group has therefore developed an implementation plan that gives priority to the most important recommendations, and is based on a realistic timetable. This will help local NHS systems to allocate resources over time through the mechanism of the local health plan. The Performance Assessment Framework (PAF) will allow the proposed national advisory committees and the Department to track implementation. As a first step, the Department will review the CHD and stroke references in the PAF, as part of the current process of revising it, to make sure that it reflects the priorities in this Strategy.

2. Some of the bodies who were asked to comment on the CHD/Stroke Task Force Report have observed that it appears to concentrate on CHD services to the apparent detriment of stroke services. While recognising that the two services have much in common, the Reference Group has responded to this criticism by developing and expanding the recommendations for stroke services.

3. CHD and stroke services are rapidly evolving disciplines; the CHD/Stroke Strategy must therefore include provision to take account of new treatments and new approaches to disease management as they become available. The creation of national advisory frameworks for both CHD and stroke, utilising Managed Clinical Networks, will allow for evaluation of current practice, the identification of problem areas, and the setting of priorities for new developments and the use of resources. This has, therefore, been the single most important goal of the Reference Group.

4. Detailed proposals for implementing the key recommendations of the CHD/Stroke Task Force (some of which have been reworded) and the Reference Group are set out in a matrix, which is available on the CHD and stroke websites, and as a working document from the Department.

5. The Reference Group recognises that three key issues underpin the Task Force's proposals:

• the development of Managed Clinical Networks, including for CHD a national or high level network (the Scottish Cardiac Intervention Network (SCIN)) responsible for high-cost and "high-tech" treatments;

• the need to increase the number of health care professionals working in the fields of CHD and stroke; and

• the development of national databases for CHD and stroke.

These issues are therefore discussed in more detail.

6. There is no point in introducing a Strategy unless it can bring tangible benefits to patients. One of the major themes of the current Spending Review is 'closing the opportunity gap', and the implementation of this Strategy will help tackle the effects of CHD and stroke in the areas of greatest deprivation. The Executive's social justice milestones recognise that poor health contributes to poverty and exclusion. There are two milestones in particular (18 and 22) which refer to reducing the rates of mortality from CHD in specific age groups. The data show that people in the least deprived areas are less likely to die from CHD than those in the most deprived areas.

7. For stroke, full implementation of this Strategy will mean:

• more rapid access to neurovascular clinics - reduction in number of first ever and recurrent strokes;

• more stroke units, leading to:

  • potentially 5,000 extra patients receiving stroke unit care annually;

  • 200 fewer deaths;

  • 200 fewer admissions to long-term care;

  • 300 more patients returning home to independent living; and

• a voice for patients and clinicians in the planning and development of services.

8. For CHD, the new arrangements will result in:

• fewer people developing the disease;

• earlier treatment, and therefore better outcomes, for those who do develop it;

• a continuation in the reduction of premature deaths; and

• a voice for patients and clinicians in the planning and development of services.

9. Many other, less concrete, but still very important benefits would derive from implementation of this Strategy. These include:

• improved patient and carer experiences of services, with better communication and information sharing;

• more efficient use of resources;

• greater retention of healthcare staff;

• improved training opportunities for future generations of stroke specialists from all relevant disciplines; and

• facilitation of clinical research to establish optimum treatments for patients.

10. Apart from these direct benefits to patients and the public, the Strategy will:

• assist delivery of CSBS standards for secondary prevention following AMI (published December 2000);

• extend development of CHD standards to all stages of the pathway of care;

• assist delivery of the CSBS standards for the journey of care for stroke patients being developed in parallel with this Strategy;

• ensure current waiting time targets are met (maximum 12-week wait for angiography from time of seeing specialist, and maximum 24-week wait from time of angiography for surgery or angioplasty);

• ensure new waiting time targets (announced June 2002) are met by December 2004 (maximum 8-week wait for angiography from time of seeing specialist, and maximum 18-week wait from time of angiography for surgery or angioplasty); and

• help implement the recommendations relating to CHD and stroke in Adding Life to Years, the report (January 2002) of the Chief Medical Officer's Expert Group on the healthcare of older people.

IMPLEMENTATION PLAN SUMMARY

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