20 April 2023

The sixth edition of the National Clinical Guideline for Stroke has been published, providing a partial update to the 2016 version.

The guideline sets out recommendations to improve the quality of stroke care across the UK, from pre-hospital care to long-term management.

RCSLT submitted recommendations as part of the consultation process earlier this year, and we are pleased to see many of these have been taken on board.

What’s changed in 2023

The guidelines include a number of changes, including some big headlines:

  • Increased recommended staffing numbers for acute and ESD/community stroke rehabilitation
  • Significant increase in the recommended intensity and dose of daily therapy
  • Dysphagia section names speech and language therapists and supports eating and drinking with risk
  • People with aphasia will get access to technology and equipment for tele-rehabilitation and it removes the term ‘no rehabilitation potential’

Staffing numbers

The RCSLT welcomes the updated staffing numbers, which mirror our policy calls. However, there is some way to go to make these figures a reality across the UK. Too many stroke services are failing to provide this staffing level, meaning people post stroke are struggling to access and benefit from vital and lifesaving speech and language therapy for their communication and swallowing needs.

Amount of therapy

The RCSLT welcomes the recommended daily increase, but we are concerned that the revised target of three hours of therapy a day may be unachievable within current staffing limitations. We have done much work with our members over the past five years to support them to transform their stroke services to deliver 45 minutes of therapy a day. This new ambitious target will require much work with professional bodies to convey this locally and ensure that our allied health professional workforce is fully supported to implement this target.


The RCSLT is pleased that the dysphagia section of the guideline has been updated and explicitly references speech and language therapists as experts in carrying out swallowing assessments and swallowing rehabilitation. It also includes references to enable and support people to eat and drink with acknowledged risk, including RCSLT’s guidance.

Aphasia Technology

Access to practice-based digital aphasia therapies is a welcome development. This sits alongside the recommendation that the term ‘no rehabilitation potential’ is not appropriate and should not be used. People with aphasia after stroke will be given the opportunity to improve their language and communication abilities for as long as they continue to make meaningful gains, under supervision from a speech and language therapist.

What next

The RCSLT will continue to work with our intercollegiate stroke working party representative as well as supporting RCSLT stroke representatives on other committees to highlight and promote the role of speech and language therapy.

We will continue to influence relevant guidelines and programmes, such as the National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), Sentinel Stroke National Audit Programme (SSNAP) and new Major Conditions Strategy, to ensure timely access to vital speech and language therapy for all people post stroke to help with their communication and swallowing difficulties.

We will continue to support our members working in stroke services across the UK to better understand these changes and help them to implement them. If you would like to find out more or get involved, please contact claire.moser@rcslt.org.