This article appears as part of the Inside the NHS newsletter.

Around 15,000 people in Scotland will suffer a stroke each year. It is the third most common cause of death annually among adults, and the most common cause of severe physical disability.

This is significantly reduced if patients get the right treatment fast enough, but performance against key targets is worse now than before the pandemic.

Stroke standards

Performance against what is known as the stroke bundle was worse in 2022 and 2023 than at "any time since the standards were revised in 2016", according to a report published on Tuesday by Public Health Scotland.

The stroke bundle has four elements: admission to a stroke unit on the same day or the day after admission, swallow screen within four hours of admission, brain imaging within 12 hours, and aspirin same or next day after admission.


Not all patients are eligible for all four components, but achieving the bundle is associated with a reduced risk of dying and an increased chance of getting back home.

While the percentage of patients getting aspirin and brain imaging on time is high (around 90%), the swallow screen and stroke unit admission rates are much lower. Just two thirds of patients are getting these as quickly as needed, down from around 80% in 2018.

Part of the problem, notes the report, is that the number of people having strokes has increased in the last few years but the number of hospital beds on acute stroke wards has reduced or remained unchanged since 2020.

Overall, the percentage of patients getting all four elements of the stroke bundle on time was just 53% in 2023, compared to high of 65% in 2017 (the target is 80%).

Thrombolysis and thrombectomy

Some patients who suffer an ischaemic stroke – where the blow flow and oxygen to part of the brain is blocked by a blood clot – are eligible for thrombolysis.

This uses a "clot-busting" drug administered via a drip to dissolve the clot. It usually has to be given to patients within four and a half hours of stroke symptom onset to be effective.

However, no hospital site in Scotland was achieving the target of having thrombolysed at least 50% of patients within 30 minutes of arrival.

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The average door-to-needle time for thrombolysis in 2023 was 56 minutes. This is much improved from more than 90 minutes back in 2010, but it has pretty much plateaued since 2017.

Patients also tend to wait much longer – 63 minutes on average – if they are admitted out of hours (that is, any time other than 9am-5pm Monday to Friday).

Meanwhile, the number of stroke patients undergoing a thrombectomy in Scotland during 2023 remains much lower than the number who would probably benefit.

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It is estimated that the procedure – which is carried out in an operating theatre and involves the physical removal of a blood clot from an artery – is appropriate for around 10% of ischaemic stroke patients.

In 2023, just 1.4% of these patients – 153 – had a thrombectomy. This is up from 112 in the previous year, and is expected to increase further with the ongoing expansion of Scotland's three new thrombectomy hubs in Glasgow, Edinburgh and Dundee (the Edinburgh service is now operational six days a week), but Scotland continues to lag behind other European countries such as Ireland where 8% of patients receive the procedure.