 The final item of business is a member's business debate on motion 6461, in the name of Gillian Mackay, on stroke associations report, keeping stroke recoveries in mind, launched on World Stroke Day. This debate will be concluded without any questions being put, and I would ask those members who would wish to speak in the debate to please press the request-to-speak buttons. I call on Gillian Mackay to open the debate around seven minutes, please, Ms Mackay. Thank you, Deputy Presiding Officer. I'm really pleased to bring forward this debate to Parliament's day on such an important topic to me. As many of you know, almost two years ago, my mum died a week after having a stroke. My grandpa had a stroke that left him with aphasia, and my gran had a stroke and TIAs as well. Stroke is something that I thought as a family we knew well, but I'm always in awe of how every stroke survivor I've met shares their story and their honesty and how it has affected their lives and the lives of their families. The mechanism with which they have come to their condition is the same, but the aftermath of no two strokes is the same. I want to thank the stroke association and everyone who has shared their story with me for their hard work and commitment, and some of them are joining us in the gallery this evening. Stroke is the leading cause of disability in Scotland. Around 10,000 people have a stroke every year, and there are around 128,000 people currently living with the effects of a stroke across the country. In my own region of central Scotland, there are around 15,000 stroke survivors. Everyone who survives a stroke has the risk of experiencing either a physical disability, cognitive problems or emotional and psychological effects or, more often than not, a combination of all three. Two out of every three stroke patients leave hospital with a physical disability and or problems with speech, communication, thinking and, of course, their emotions and mental health. Stroke survivors often say that people will tell them, ah, you don't look like you've had a stroke. This is a result of a lack of awareness about these hidden effects of stroke. It's not all physical and the psychological effects can often be as or more debilitating to the individual. Last month, the stroke association published a report looking specifically at the hidden effects of stroke. Keeping stroke recoveries in mind looked specifically at the psychological and emotional impact on a person after their stroke. The findings mirror those of a similar report published 10 years ago. The main message being that psychological and emotional recovery is not viewed on equal terms as physical recovery post-stroke. The stroke association spoke with more than 100 stroke survivors and 87 per cent of them want to see equal access to physical and psychological care within their rehabilitation, yet only 25 per cent report receiving enough psychological and mental health support. Ten years has passed. The research continues to tell us the same thing, but everyone's experiences are not improving. The Scottish Stroke Psychology Forum has supported the stroke association with this and provided a tiered model that allows everyone involved in stroke care to be trained and supported to deliver psychological care for stroke patients. We all know of the tight financial constraints on the health budget, and so this tiered approach to delivering psychological care will help to alleviate future pressures. By ensuring that people get the emotional and psychological help that they need at the beginning, the long-term health and social care costs will be reduced as they start to rebuild their lives earlier. There is a strong evidence base to support this. A lot of research has been carried out that looks at the economic benefits of providing early intervention, which all found a strong financial saving long-term. This is a solution to current problems that both stroke patients are facing but also the overall health and social care budget. I was also grateful to hear from Paula from Glasgow at one of our cross-party group meetings on this topic. She spoke so openly and honestly about the psychological and emotional impact that she faced after her stroke, which she had a year ago. She explained how overnight everything changed her heart when she went from being a wife, working full-time and enjoying so many outdoor activities to not being able to do everything that she used to get such enjoyment from. She started to lose control of her emotions and her stroke added a heightened sense of anxiety like nothing that she had experienced before. After some time, Paula spoke to her consultant and he informed her that this is something that often affects people after a stroke, but there are inadequate resources to cope with the number of people who need support. With support from her family and empathy from health and social care staff, Paula has made a good recovery. Unfortunately, that is not the story for everyone and we all have a role to play in changing the narrative from stroke being something that only affects you physically to a condition that affects the whole person. I would encourage everyone to speak with stroke survivors and their families and their constituencies in regions about the mental impact that stroke has had on them. It will absolutely open your eyes the way in which people's worlds have changed. Grief is a way of describing the feeling that I have heard from several stroke survivors. Grief is not just confined to those who have lost someone to stroke but to those who have lost what their previous life was, whether that be through any condition from paralysis to aphasia. The survivors and their families often have to pick up the emotional pieces, muddle through and try to make the best of it. I hope that through that debate and other work we can put a focus on the mental health support that many survivors need. I am keen to support the Scottish Government to drive forward improvements in that area and I was pleased to see the progressive stroke pathway document published earlier this year. I know that that document is vast and wide-ranging but it includes a focus on psychological care for stroke survivors, which is encouraging. However, we must act now to ensure that that translates to changes for patients. Through early intervention, we can give people the chance to rebuild their lives and save the health and social care services significant money across the long term. I hope that the cabinet secretary will be able to update us this evening on when the Revised Stroke Improvement Plan will be published and that it will give appropriate resource to the plan. I hope that the cabinet secretary will also ensure that stroke care across the 14 health boards is consistent so that everyone receives the same level of care. I repeat my thanks to the Stroke Association and all those stroke survivors who have given their time and their effort to the cross-party group and look forward to hearing everybody's contributions this evening. Thank you, Ms Mackay. I now call Paul MacLennan to be followed by Ros McAll, around four minutes please, Mr MacLennan. Thank you, Deputy Presiding Officer. I thank Gillian Mackay for bringing forward this member's debate this evening. I know that the subject is very motive for her. We were talking about that yesterday, and I pay tribute to the work that she has done in this area, so my thoughts are worth you, Gillian. I also thank Katie McGregor for her briefing from the Stroke Association for the debate tonight. It is comprehensive, extensive and informative, as have I am also a member of the cross-party group on strokes. My dad died from vascular dementia about four years ago after a series of TIAs. He lost his ability to speak about three years ago. That has impacted on his own mental health and on my own and on the rest of the family. There are 2,000 stroke survivors in East Llywodrae, and that is about one in 50 adults. 12,500 people have been diagnosed with high blood pressure. That is one in eight adults in around 1800 of AF, actual fibrolation. That is a heart condition that causes an irregular heartbeat and raises the risk of a serious stroke. As Gillian mentioned, in March 2022, the Scottish Government published a progressive stroke pathway, which was produced by the National Advisory Committee on Stroke. That document sets out a vision of what stroke care in Scotland should be. Again, as Gillian said, the next year, the Scottish Government is due to publish a revised stroke improvement plan based on recommendations made in that progressive pathway project. The PSP states that psychological care should be available to all patients in line with local delivery plans, and I will touch on that a little bit later on. The Stroke Association's report, keeping stroke recoveries in mind, found that stroke survivors are still not receiving the psychological support that they need. The report calls for a model that is developed by the Scottish Stroke Psychology Forum to be included in the upcoming stroke improvement plan and given appropriate financial and workforce resource. The report found that 87 per cent of stroke survivors report that they want to see equal access to physical and psychological care within their rehabilitation, but at the moment only 25 per cent think that they are receiving enough mental health support. 94 per cent of people said that they experienced a mild impact on their psychological and emotional wellbeing after their stroke. 75 per cent of respondents report that they did not get enough support in hospital, and 68 per cent of people did not feel that they got enough support once home from hospital. Why is giving greater emphasis to emotional care so important? Stroke is the biggest single cause of adult disability in Scotland. Two out of every three stroke patients leave hospital with a physical disability. People need support to come to terms with a huge change in their life. People carry the impact of their stroke with them for the rest of their life. Even with people with mild disability or whoever make a complete physical recovery after a stroke, fatigue and psychological issues can hugely affect the quality of life. A emotional impact has been included in the two previous stroke improvement plans, but issues as they said still persist. In the 2022 Scottish Stroke Care Audit, the category relating to psychological support was the lowest-performing category of all stroke improvement priority categories. The Stroke Association's lived experience of stroke report in 2019 remains the biggest ever largest conducted UK wide survey and found that nine out of 10 stroke survivors reported experiencing at least one cognitive effect. The same number of those explains at least one physical effect. Three quarters of stroke survivors experience the change in their mental health. They may develop depression, anxiety or suicidal thoughts. By 2035 in Scotland, the incidence of stroke is expected to double compared with 2015 figures. When a physical illness, like stroke, is accompanied by mental illness, it worsens outcomes such as life expectancy. In closing, I once again thank Gillian Mackay for bringing forward this debate, the Stroke Association, for all the work that it is doing in the briefing. Finally, the one key point is to ensure that all of us work with our health boards to ensure that we keep stroke recoveries in mind. I know that the delivery of the service in different parts of the country varies from different local authorities. I have been trying to speak to my lone local authority on that, and I struggle to get issues brought up in that regard. We need to ensure that stroke survivors receive the psychological support that the need has been highlighted by Gillian Mackay. I now call Ross McCall, to be followed by Jackie Baillie, around four minutes, please. Having a stroke is a life changing event. It affects around 10,000 people every year in Scotland, and there are more than 128,000 people in the country living with the long-term consequences of their stroke. The Stroke Association says that, in its reports, you cannot always see the damage a stroke causes. It is hidden inside, but we know that it is one of the biggest issues for people and their families. Emotional and psychological wellbeing for someone after a stroke is just as important as their physical recovery. The sense of loss and grieving for the life that has been so abruptly altered is the first and most difficult challenge a stroke victim will need to overcome. In the simplest terms, a stroke victim will need to mourn the person they were before they can become the person they will be, and I speak from experience. In February 2021, in lockdown again, my husband collapsed from a hemorrhagic stroke and went through surgery to reduce the bleed on his brain. He had no idea what was happening, no concept of the situation. He was in intensive care in Edinburgh and I was 50 miles away home when depression took hold. He would not eat, he would not engage in any way, he didn't want to know. Usually I would have been able to visit, I would have been able to support him, I would have been able to simply hold his hand, but because of the extraordinary circumstances brought on by the pandemic, a psychologist's input was requested and the doctors feared he would not recover even though the operation was a success. Over the course of many difficult phone calls, I had to try and describe him, his likes, dislikes, his goals, his dreams and even though I had no idea that he would be able to experience them again, I had to make a sense of what little talks they had managed to pick up from him. His journey back to health was one in those conversations and that psychological intervention. Deputy Presiding Officer, you will be aware that not all strokes have the same outcomes and my husband's experience is an example of that. Most people think that a stroke is a condition that affects someone's physical health and of course those consequences are extremely serious. However, a result of that is that the assumption ends, that the care ends when the physical symptoms end and this assumption that contributes to people not receiving to the psychological care they desperately need. The Stroke Association consulted with over 100 stroke survivors and the results are staggering and I will repeat Paul MacLennan's comments. 94 per cent of people say that they experienced an impact on their psychological and emotional wellbeing after a stroke. 39 per cent reported severe impact on their mental and physical health. Three quarters said that they did not get enough of emotional support in hospital and 68 per cent felt that they did not get enough support when they went home. To battle, to truly surviving a stroke, is one or lost in what the victims can believe they can achieve and that is not catered for and we must do better. I have concerns that immediate stroke, immediate national stroke care is moving in the wrong direction. Members will be aware of the set of standards that national stroke care often referred to as the stroke bundle. This includes having access to a brain scan within 12 hours and access to aspirin as a blood thinner within a day of arriving at hospital. Meeting those targets for care ensures that someone has the best chance of recovery. In my region, NHS Fife and NHS Forth Valley are meeting those standards, but Scotland is not. There is also a concern being raised by clinicians regarding funding reductions for the thrombectomy surgery programme. When a thrombectomy not only saves lives but reduces the damage to the brain and increases the chances of a fuller recovery, it also saves £47,000 per person in on-going treatment, so to me that seems like a win-win and I urge the cabinet secretary to look again at this issue. In conclusion, I believe that the ability for my husband to have bedside psychological assessment and one-to-one care saved his life just as much as the surgery did two weeks before and they will have my unending support and thanks, so I highly support the motion brought forward by the member. I now call Jackie Baillie to be followed by Alexander Burnett. I would like to begin by congratulating Gillian Mackay for securing this member's debate on the Stroke Association's new report, keeping stroke recoveries in mind. We have heard from personal testimony how having a stroke is a life-changing event. Within a matter of minutes, stroke impacts upon not just a person's physical health, but their sense of self too. When a stroke often comes with a loss of independence and agency, this can be a very difficult thing to adjust to for both survivors and their families. That is why the report is just so important. Physical recovery from a stroke, which is where most of the focus is usually placed, is just one aspect of recovery. Research undertaken by Chest Heart and Stroke Scotland found that people living with stroke conditions are at a significant risk of poor mental health. The Stroke Association's report points out that 95 per cent of stroke survivors report a change in their mental health as a result of their stroke. I did not realise that, but there are apparently 1,800 stroke survivors in Dumbarton. Many of them tell me that they do not feel adequately supported when it comes to dealing with their mental health. The report helpfully outlines the important role that NHS Scotland can ensure that the emotional and psychological needs of stroke survivors will be met going forward. However, feeding good psychological care into clinical practice is not beyond us. Stroke care can take on a holistic needs-based approach that is currently missing in the service. We can do that by educating and training staff, by ensuring that they are supported in their roles to enable them to take on these additional tasks. Earlier this year, the 2022 report for the Scottish Stroke Improvement programme was published. It showed that too many stroke patients did not get the care that they needed in the last year. I appreciate that there was a pandemic, but the challenges predate Covid. What is true—I think that we can all agree—is that healthcare staff have been incredible, working round the clock to look after patients, but they are exhausted and the system is failing them too. We will all acknowledge that improvements can and should be delivered for stroke care, but they cannot be delivered without ensuring decent pay and safe staffing levels. Healthcare staff are already at breaking point. It is important that, when we ask more of them, we support them properly and it gets beyond warm words. We need to act. It is important to note that there is a significant variation in performance against stroke care standards among health boards. We should be able to have the same standards but better standards wherever you are in Scotland. When seeking to address psychological stroke care, it is vital that that trend is not replicated. Stroke care should also extend beyond a stay in hospital if it is to be effective, as 68 per cent of people say that they did not feel that they got enough support once they were at home away from hospital. I know that, at the last election, the First Minister pledged to support the roll-out of Chest Heart and Stroke Scotland's hospital-to-home service across the country, something that we would all support because it offers support already to 38,000 people living at home with chest heart and stroke conditions. I hope that the Scottish Government will do more to honour that commitment because the service is not yet provided across all 14 health boards. I hope that those issues will be addressed by the Government to allow health boards to appropriately resource and deliver the progressive stroke pathway that we all agree is desperately needed. I now call Alexander Burnett, who will be the last speaker before I ask the Minister to respond. Around four minutes, please, Mr Burnett. Thank you, Deputy Presiding Officer. I start by thanking Gillian Mackay for securing this important debate. Important because, as we heard, the stroke association estimates there are 128,000 people living with the effects of a stroke in Scotland, 1,400 in my constituency, Aberdeenshire West alone. Stroke is a leading cause of death and long-term disability in Scotland, and for many survivors there will be lifelong emotional and psychological effects. A key call of a stroke association's feeling-overwhelmed report in 2013 was for improved emotional support, but, shockingly, almost a decade later, their recent report has highlighted that nothing has changed. A constituent of mine, Eric, who lives in a boin, has been an avid campaigner since he suffered a stroke in 2004, writing a book, Man, Dog, Stroke and helping to run an exercise class for stroke survivors in D-Side. Eric knows all too well that people with the potential for more physical and psychological recovery are not receiving it and are having to go private to get a better quality of life, because psychological support has been overlooked and we are just a quarter at just receiving enough mental health support. These results are just as appalling as they were almost a decade ago. Such care should start as soon as someone is diagnosed with a stroke. A stroke association's key recommendation is to improve psychological care and implement the national model of psychological care and stroke services. Unfortunately, there just is not an appropriate workforce to ensure that this will happen, and with less than eight full-time equivalent psychologists with stroke services in Scotland, the progressive stroke pathway highlights what important work is needed. However, for each health board to introduce an effective plan, the Scottish Government needs a stroke-specific workforce. I would also like to note that there are a range of other delays to treatments for stroke survivors. Thrombolosis door-to-need all times are variable across Scotland and treatment times have not been improving, despite this being an urgent time-sensitive treatment at the onset of stroke. Progress on thrombectomy services is also proceeding too slowly, even though it has the potential to reduce the likelihood of disability for hundreds of survivors each year. There has been available for suitable stroke patients elsewhere in the UK for some time. The pandemic led to a lot of changes in the health and social care system, which would undoubtedly have had an effect on the treatment of stroke survivors. People may have delayed seeking help or had to wait increasingly longer waiting times, which would have worsened their condition. We also know that a delayed discharge from hospitals is increasing and that there is a lack of social care available to provide the necessary support to survivors. However, as we have heard today and in so many other health debates, issues with psychological care for stroke survivors were an issue long before the pandemic. No health board in Scotland has a staffing level that is meeting clinical guidelines and psychological care is a postcode lottery. That is completely unacceptable. Therefore, I urge the Scottish Government to ensure that stroke survivors are getting the cognitive, emotional and psychology help that they need. Thank you very much, Deputy Presiding Officer. I thank Gillian Mackay for securing this very important member's debate. I thank the Stroke Association for providing a briefing to elected members right across the chamber. There are a number of reasons why we have members' debates in this Parliament, as members are very acutely aware. Sometimes it is to highlight an excellent local project, sometimes it is to rightly praise an individual in our constituencies or regions, or sometimes, and I think that this is the case for this debate, it is to put a spotlight on an issue that does not get enough of a national earing. I think that Gillian Mackay has done that with this debate because, as she and others have said in an excellent contribution, she said that, often when people think about stroke, they think about the physical impact of a stroke. As she rightly said in her contribution, they are not inconsequential of those physical impacts and impairments that a stroke may cause, but less is said about the psychological impacts. I am very grateful for all members—for Gillian Mackay, first and foremost—for shining a spotlight on the issue through her motion, but I am also very thankful and grateful to members who have contributed sometimes to their own personal experiences that Gillian Mackay did in terms of her own family, something that she has spoken about on a number of occasions in this chamber and every time very powerfully. I was very grateful to Ros McAul for also sharing her experience in relation to her husband. I wish him all the very best on his own recovery journey, but my goodness, how difficult that must have been for Ros McAul and her family at any time, let alone with the legal restrictions that were in place at the time. I am very grateful to her for she owes us nothing but to come to this chamber to share that story, which has been very powerful and insightful. In terms of the issue of psychological support—that is where I will focus a large part of my remarks, so I will try to address some of the issues that have been raised by fellow elected members—the mental health and addressing the impacts of the cognitive impact of stroke is absolutely a priority for this Government. We are in the midst of developing that new mental health and wellbeing strategy, and we will not ignore the long-term mental health impacts of conditions such as stroke. We are absolutely committed to ensuring that patients who have suffered strokes receive the best possible care to enable them to live longer, healthier and more independent lives. Key to that has to be ensuring that we meet their mental health needs and cognitive needs as much as their physical needs. As best we possibly can, I certainly try to do this myself, but I will liaise with those people who have been impacted by stroke—those with lived experience—of suffering strokes or, indeed, their families. We do that through the national stroke voices group. In listening to the experiences of those who have been affected by stroke and the findings presented by the stroke association, it is clear that more clearly can be done to address the psychological consequences of stroke. The report references the progressive stroke pathway, which has been mentioned by a number of elected members who contributed this afternoon, developed by the National Advisory Committee for Stroke, and the recommendations that it makes regarding psychological care. In response to that, the annual reviews of NHS boards and stroke services will now include a requirement for boards to demonstrate their provision of psychological support for those who have been affected by stroke. In line with the national model of psychological care for stroke, that is therefore putting the psychological impacts of stroke at the forefront of the mines over NHS chairs and chief executives when those reviews take place. Boards will be asked to implement a documented programme for promoting awareness, screening and treatment of the psychological consequences of stroke. Psychological care should be available to all patients who require it, and there should be documented evidence of a clear referral pathway for accessing psychological services. I take the point that I made by a number of members here that they feel that that is not done in a consistent manner, hence why we make it a requirement in relation to the annual reviews to get that consistency right across the board. We are also asking boards to ensure that anyone who has suffered a stroke has offered a formal review six months after their stroke event, so we need to get that support immediately. We need to make sure that that is followed up. We know that psychological consequences of stroke do not always manifest themselves immediately. We have heard that from those who have suffered from stroke, or indeed their family members. We hope that that approach will ensure that individuals are able to receive the psychological care that they need, and when they need it. The provision of psychological care in six-month reviews will be reported in all future Scottish Stroke Improvement programme annual reports. I want to turn to a couple of the issues that were raised that I may not have covered already. We will be asked about the stroke improvement plan when it will be published by Gilliam McIable. I will happily update members where in the midst of that discussion at the moment, we are under considerable financial constraints, so we want to ensure that when we present that plan and publish that plan, it has with it the consequential funding that will be required in respect to that plan. I will make sure that we update Gilliam McIable and any other member that has a particular interest. Rose McAll, Alexander Burnett and other members made an important point about the funding of life-saving thrombectomy services, a point that is well-made. It is not a point that I disagree with. To both members, we are under extreme financial constraints. I am not going to stray into the reasons and the politics around that. Really difficult decisions have got to be made. That is now having an impact on service delivery, whether that is to deal with high inflation costs, whether that is to deal with really high pay deals that we have to offer given the high inflation costs that our workers are currently facing. However, it should be acknowledged that forecast thrombectomy expenditure for this current financial year represents an almost 20 per cent increase on the last financial year, so we will continue to invest in thrombectomy services because we know and I know as health secretary the value of those services. On the stroke bundle as well, absolutely recognised that delivery of stroke care bundles is of crucial importance to the provision of high-quality stroke care. That is very much emphasised in the progressive stroke pathway. Monitoring of performance against the stroke bundle standards through the Scottish stroke care audit allows us to identify whether those gaps absolutely exist. You are not going to get a denial for me that there are gaps. There are challenges in the delivery of high-quality stroke care and where we need to implement quality improvements. I am aware that I am saying slightly over time, Deputy Presiding Officer, but at the last point I may just emphasise that the Scottish stroke audit is raised by a number of colleagues, Paul McLean in his contribution, Jackie Baillian in her contribution as well. Jackie Baillian was right to point out that there are clearly areas that we need to improve on. There have been some areas where there has been some improvement, such as brain imaging and aspirin initiation, but there are many other areas where we have seen standards slip. Obviously, it is largely down to the pressure of the pandemic, but Jackie Baillian is right to also mention that those were challenges pre-pandemic to. She has my assurance, as does everybody else in this chamber, that the psychological support needed for those who suffer from a stroke is at the forefront of our minds. I thank, once again, Gillian Mackay for bringing this important issue to the parliamentary chamber. Thank you, cabinet secretary. That concludes the debate. I close this meeting.