STAFF absences and bed shortages due to Covid have been blamed for a worsening performance against key stroke targets in Scotland.
Two of the major 'stroke care bundle' benchmarks associated with recovery - admission to a specialist stroke unit within 24 hours of hospital admission, and swallow screen within four hours - were achieved for around seven in 10 patients last year, well short of the 90 per cent and 100% targets respectively.
This was down from just under 80% in 2020.
Source: Scottish Stroke Improvement Programme, 2022 national report. Red = statistically significant decline; Yellow = no change; Blue Square = previous position in 2020
The annual Scottish Stroke Improvement Programme states that these declines are "are likely to reflect the impact of the ongoing Covid-19 pandemic on patient flow, and availability of stroke unit beds and staffing".
It states: "During 2021, we have seen a much broader effect of the pandemic on hospital and stroke services.
"At times, stroke services across Scotland will have suffered stroke unit closures because of outbreaks among patients and staff.
"In hospitals where patients were cared for in stroke units, which did not have predominantly single-room accommodation, there were issues around Covid-19 contacts and isolation.
"This meant that even when the stroke unit was open, beds were, by necessity, left empty (blocked) and the capacity was reduced."
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The report also highlights a steep increase in the number of stroke incidents responded to by the Scottish Ambulance Service, from 16,635 in 2018 to a record 25,368 last year.
Incidents triaged as stroke by the Ambulance Control Centre were at a record level in 2021
The target ambulance response time for the most serious strokes is 19 minutes. This is the time between a 999 call being received and an available ambulance dispatched.
This has increased steadily since 2019, and averaged just over 11 minutes for Scotland as a whole last year.
However, NHS Ayrshire and Arran, NHS Greater Glasgow and Clyde, and NHS Lanarkshire were identified as outliers with average response times of around 18 minutes, 21 minutes and 22 minutes respectively.
The report states that the reasons for this "include high ambulance service demand and longer hospital turnaround times, creating demand versus capacity mismatch".
Average ambulance response times for the highest stroke severity (from 999 call to available ambulance dispatched)
In 2021, almost one in 10 stroke patients received thrombolysis - a clot busting drug injection.
The average "door-to-needle" time - the time between a stroke patient's arrival at a first hospital and receiving thrombolysis - was 52 minutes last year, compared to 51 minutes in 2020.
John Watson, associate director Scotland for the Stroke Association, said the report "clearly shows too many stroke patients did not get the care they needed".
He acknowledged that while there had been some improvements nationally towards meeting targets on brain imaging and aspirin delivery, overall performance on the 'stroke care bundle' of key measures had deteriorated.
Mr Watson said: "The national figures for stroke care bundle performance and door to needle time for thrombolysis - key measures of the health of our stroke systems - were flatlining well below the standards required, pre-pandemic.
"Improving those was always going to be challenging whilst dealing with the impact of Covid-19. However, the latest national figures show a significant decline in stroke care bundle performance.
"They show that thrombolysis figures nationally have pretty much stayed static, but only at already unhappy levels.
"There also remains significant variation in performance against the standards amongst health boards – so that the stroke care you receive is too heavily dependent upon where you live."
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A Scottish Government spokesman said: “Despite the continued and unprecedented challenges presented by the Covid-19 pandemic, this report highlights areas where a high level of care is provided for stroke patients, including improvements in the number of patients who receive brain imaging within 12 hours of arrival to hospital.
“We recognise that there are areas within stroke care that have proven particularly challenging and we are committed to continued improvement.
"We expect health boards to identify aspects of their stroke services which do not meet the Scottish Standards and to work to improve standards of care locally.”
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