Intended for healthcare professionals

Rapid response to:

Practice Guidelines

Rehabilitation after stroke: summary of NICE guidance

BMJ 2013; 346 doi: (Published 12 June 2013) Cite this as: BMJ 2013;346:f3615

Rapid Response:

Re: Rehabilitation after stroke: summary of NICE guidance

Dear Sirs,

The new NICE guidelines on stroke rehabilitation1,2 recognise that high quality stroke care services should include physical rehabilitation, as well as stroke-specialised psychological and emotional support to stroke survivors. We do, however, wish to stress the serious financial implications that can bring considerable anxiety and stress to the stroke survivor and their families during rehabilitation.

In Wales, we have formed a multi-professional student group3, as a collaboration between Institute for Healthcare Improvement Open School chapters4, specifically to work with higher education, healthcare and volunteer organisations, including the Stroke Association and patients themselves. We meet monthly to learn about the role of each healthcare professional in the stroke care pathway through peer-led teaching, as well as run group activities such as identifying the ‘Top 5 basic care needs’ that all students can assist stroke patients with regardless of professional role whilst on placement. Stroke patients share their stories at our meetings, and their experiences consistently highlight the harsh realities of ‘life after discharge’. Recurring themes include frustration with the lack of available psychological support, and very often the anxiety resulting from the financial burdens associated with long-term care needs during rehabilitation. All patient stories we have heard rate highly the support provided up to 6 weeks post discharge, but NHS and local authority funded care after this point can diminish rapidly, leaving many patients without access to full reablement services, or being forced into funding it themselves5.

One stroke survivor shared that he had saved his whole life for early retirement. Following his stroke, he was unable to return to work and his wife gave up her job to assist him with activities of daily living. The family has since endured nearly a decade of financial hardship living off their savings. Now that they are depleted of their savings, they are only now entitled to help in adapting their home. There is a huge discrepancy between the level of care available in the acute phase and in the following rehabilitation phase. This shortcoming forces many stroke survivors to spend their life savings before they can access even basic care services funded by the NHS and social services.

Yours faithfully,

Miss Hope Olivia Ward, 3rd year medical student, Cardiff University
Miss Beth McIldowie, 3rd year medical student, Cardiff University
Miss Sarah Kibble, 3rd year medical student, Cardiff University
Dr Amanda Squire, Inter-professional education lead, Cardiff Metropolitan University
Dr Andrew Carson-Stevens, Clinical Lecturer in Healthcare Improvement, Cardiff University School of Medicine (corresponding author:

1. National Institute for Health and Care Excellence (2013) [Stroke Rehabilitation]. [CG162]. London: National Institute for Health and Care Excellence.
2. Dworzynski K, Ritchie G, Fenu E, MacDermott K and Playford ED. Rehabilitation after stroke: summary of NICE guidance. BMJ2013;346:f3615
3. Squire A, Carson-Stevens A, Jones A, Hearle A and Evans E. 2013. Joined up care – interprofessional approaches to improving patient care. [Poster] 17th May 2013 Learning and working together to improve safety through better prescribing, Cardiff Hilton Hotel.
4. Institute for Healthcare Improvement Open School, 2013.Overview. Available at: [accessed 9 July 2013].
5. The Stroke Association. Struggling to recover. May 2012. London: The Stroke Association

Competing interests: No competing interests

11 July 2013
Hope Olivia Ward
3rd Year Medical Student
Beth McIldowie, Sarah Kibble, Amanda Squire, Andrew Carson-Stevens
Cardiff University
Heath Park, Cardiff, CF14 4YS