A powerful new critique accuses Scotland of repeatedly choosing expensive rescue over affordable prevention in stroke care, despite having all the data, tools, and evidence needed to slash thousands of preventable strokes every year.
For 25 years the NHS has poured resources into emergency response while leaving upstream risk factors largely untouched in the most deprived communities. Experts now warn this approach has reached breaking point.
Scotland Still Pays Heavy Price for Preventable Strokes
Around 8,000 people suffer a stroke in Scotland every year, and more than 1,000 die within 30 days, according to the latest 2024 Scottish Stroke Care Audit.
Stroke remains the leading cause of adult disability in Scotland. One in four survivors leave hospital with severe disability. Deprived areas see rates up to 50 per cent higher than affluent ones, Public Health Scotland data shows.
Most strokes are caused by known, treatable conditions. High blood pressure, atrial fibrillation (AF), smoking, high cholesterol, and diabetes drive the vast majority of cases. Yet control rates remain stubbornly poor in many practices.
Only 58 per cent of patients with known AF were anticoagulated before their stroke in 2023, the audit revealed. Blood pressure control in primary care has actually worsened in some health boards since 2019.
Why Prevention Keeps Getting Pushed Down the List
Scotland has never organised its national stroke strategy around prevention, despite repeated political promises.
The current Progressive Stroke Pathway, launched in 2021, focuses heavily on hyper-acute care and rehabilitation. Prevention gets just one short section and no dedicated funding stream.
NHS boards receive financial incentives for thrombolysis rates and scanning speeds, but almost nothing for improving anticoagulation uptake or blood pressure control in high-risk groups.
One senior stroke physician told us: “We are rewarded for being brilliant at the dramatic bit at the end, but not for stopping people reaching that point.”
Targeted Prevention Clinics Could Transform Outcomes
Scotland already knows exactly who is at highest risk. GP records flag hundreds of thousands of people with uncontrolled hypertension, untreated AF, or very high QRISK scores.
A new proposal calls for every health board to set up community-based, nurse-and-pharmacist-led stroke prevention clinics. Patients would receive automatic invitations when their calculated risk crosses a threshold.
These clinics would deliver same-day blood pressure checks, instant anticoagulation decisions, statin initiation, and smoking cessation support under consultant supervision.
Pilot schemes in Lanarkshire and Grampian have already shown reductions in stroke admissions of up to 18 per cent in targeted postcodes.
STROKEBASE: 24/7 Expert Advice at Every Front Door
The second major proposal is the creation of STROKEBASE, a national 24/7 telephone and video service staffed by consultant stroke physicians.
Much like the existing TOXBASE toxicology service, any GP, ambulance clinician, or emergency department doctor could call for immediate senior advice on complex cases, post-window presentations, or borderline thrombectomy decisions.
The service could launch within months using existing Scottish stroke consultants on a rota, topped up by UK-based doctors working remotely under strict NHS governance.
Early modelling suggests STROKEBASE alone could increase appropriate thrombolysis rates by 15 per cent and reduce unnecessary admissions by thousands each year.
Time to Choose Prevention Over Heroics
Scotland spends around £800 million annually on stroke care, most of it on acute hospitals and long-term disability support.
Shifting just ten per cent of that budget into targeted prevention and expert decision support would save thousands of strokes and tens of thousands of bed-days within five years, experts estimate.
The evidence is overwhelming. The tools are ready. The only thing missing is political will.
For the first time in a generation, stroke specialists, public health doctors, and primary care leaders are speaking with one voice: Scotland must finally stop managing failure and start preventing it.
What do you think? Should Scotland declare stroke prevention a national clinical priority and fund it properly? Drop your views below and tag #PreventStrokeScotland if you’re sharing on social media.
