‘Where will resource and funding come from for additional rehab?’

Stroke survivors who have continuing impairment or limitation on their activities should be offered additional rehabilitation, new NICE guidelines have recommended – but concerns have been raised over its delivery. 

The recommendations, released today, say that people who have had a stroke should be offered needs-based rehabilitation for at least three hours a day on at least five days of the week, covering a range of multidisciplinary therapy including physiotherapy, occupational therapy and speech and language therapy. This is an increase in rehabilitation compared with NICE’s original guideline published in 2013.

Although stroke is one of the biggest causes of death in the UK, thanks to improvements in organised stroke care and new acute treatments, most people survive a first stroke. It is estimated that there are around 85,000 strokes every year in England, and around one million stroke survivors, many of who are living with its long-term effects.

However, while welcoming the recognition that greater levels of rehab are needed, questions were being asked as to how it would be delivered, with ongoing and growing pressure on resources.

Steve Jamieson, chief executive of the Royal College of Speech and Language Therapists (RCSLT), highlighted the existing huge demand for speech and language therapy, and that people may be at risk if they were not receiving often life-saving support due to resources being overstretched.

“While we welcome the recommendations for more rehabilitation, such as regular three hours of therapy, clarity is needed on what this will entail,” he said.

“We urge NICE to provide detail on how these recommendations will be implemented and where the resource and funding will come from.”

NICE said evidence reviewed by an independent committee for the update showed more intensive rehabilitation improved quality of life and activities of daily living. They also heard from people recovering from stroke, and their families and carers, who felt strongly that more intensive rehabilitation would be useful in helping them to recover faster.

Professor Jonathan Benger, Chief Medical Officer at NICE, said: “We recognise the challenges the system faces in delivering these recommendations, not least the problems inherent in increasing service capacity and staff. We also know current practice is inconsistent, even when it comes to implementing our previous recommendations.

“But equally it shouldn’t be underestimated how important it is for people who have been left with disabilities following a stroke to be given the opportunity to benefit from the intensity and duration of rehabilitation therapies outlined in this updated guideline.

“By focusing on what matters most, we need to find ways to enable people who have had a stroke to access the level of rehabilitation that supports their recovery and meets their long-term needs and goals.”

Dr Maeva May, associate director for policy and research at the Stroke Association, said: “We warmly welcome today’s announcement that NICE is recommending an increase in rehabilitation therapies for people who are recovering from stroke. 

“Sadly, stroke is still a leading cause of adult disability and it has wide-ranging impacts so it’s vital that every stroke survivor gets the support they need to give them the best chance of recovery.

“Research shows that frequent and more intense rehabilitation leads to better recovery following a stroke but many stroke survivors only receive a fraction of what this guideline recommends, leaving many without support and limiting their improvement post-stroke.

“Every stroke is different and so is every recovery, so it’s important that stroke survivors can access person-centred support for as long as they need it, so they can regain their independence and rebuild their lives after stroke.”