Scotland's leaders must step up to tackle stroke crisis

John Watson writing in The Times Scottish edition on 27.2.26

Two keenly awaited events in May – the Scottish elections, and my imminent retirement – leave me reflecting on why Scotland performs so badly on stroke care.

Problems across health and social care loom over us. Our services, when they work, do wonderful things, but they cannot cope with the demands placed on them.

Any system that is overloaded will fail people. And despite the heroic efforts of staff the stories of corridor care, ambulance delays and missed diagnoses keep coming.

Stroke perfectly illustrates the problem. A huge part of health and social care in Scotland, stroke is the third biggest killer and the leading cause of adult disability. Stroke also generates enormous resource demands in emergency departments, hospital beds, social care, etc.

Recent decades have seen fantastic advances in stroke medicine. Given the chance, stroke teams now have a range of excellent interventions and supports that can transform lives.

Yet half of stroke patients in Scotland don’t even get the basic “Bundle” of supports that should be standard. Thrombectomy is one of the most effective treatments available on our NHS, yet Scotland has less than half the thrombectomy rate in England.

The cost, in human lives, illness and disability, is devastating. Crucially, leaving so many people needing extended care and support is madness from a business perspective too.

Because stroke care also promises solutions. The evidence clearly shows that getting stroke care right delivers much better outcomes for patients, but also that it greatly reduces hospital stays and the need for ongoing support. Improving stroke care reduces the demand on the system that should be top of the next government’s “to do” list.

Scotland lags so far behind because our political and service leaders won’t stand up and be counted. Fine words and promises from Scottish Government count for nothing when their Budget doesn’t invest the relatively small amounts needed for equipment and staff, or give anything more than year to year funding. Our 14 health boards somehow can’t organise amongst themselves to line up the necessary planning and collaboration to assess, move and treat patients across geographical boundaries.

Where is the leadership? Nobody will step away from the routine and familiar, identify the changes that can turn things around, and take personal ownership of making sure they happen.

Is it pessimism that things can actually improve? If so, you shouldn’t be in charge.

Or is it the safety of the herd, the easy appeal of carrying on as we are because everyone is failing and you can get away with it?

Who will attach their name to something we all know works, and say, “I will make this happen”?