LUNA PDG WP1 · working brief · 18 October 2026

NHS and non-NHS infrastructure after stroke with aphasia

England, Scotland, Wales and Northern Ireland. Verification is stated per nation: England and Wales against primary documents, Scotland and Northern Ireland partly.

Prepared 18 October 2026 for Professor Madeline Cruice (Maddy). Working brief. Verification status is stated per nation below.

Maddy's question: what NHS and non-NHS infrastructure may an adult pass through for health care after a stroke with aphasia in England, and how does this differ in Scotland, Wales and Northern Ireland?

Verification status at a glance

  • England: verified against the NHS England National Stroke Service Model (May 2021, PAR406). Two of Maddy's figures are not supported by the text I read, and one is reframed. Details below.
  • Wales: verified against the NHS Wales National Stroke Service Standards (Version 1, October 2025) and the Welsh Government Quality Statement for Stroke (4 February 2026). SLT staffing and delivery figures also verified against an RCSLT report (2026).
  • Scotland: partly verified. Full text of the acute and rehabilitation pages could not be retrieved (both 404 on gov.scot). The progressive stroke pathway (gov.scot) was seen in search extracts, not read in full. The 2020 Framework page returned 404, so the Framework itself is not confirmed as live. The National Advisory Board for Rehabilitation is marked inactive on gov.scot (confirmed).
  • Northern Ireland: partly verified. The DoH hyperacute page (undated extract) lists eight acute stroke units, says Daisy Hill has no acute stroke service because of staffing, and says the preferred hyperacute network was due by summer 2025. The outcome of that decision is not confirmed. Acute-stage structure not established. The "five Trusts" point is supported by a hscni.net page of undated status; the current structure has not been confirmed.
  • Not verified: the "20 ISDNs" count (not found in the England text I read); the ICSS "up to six months" phrasing as a fixed period (see England); the Wales "stepped care, WALES principles" detail (not found in the Quality Statement text read).

Stage-by-stage route

Stages: (1) pre-hospital and emergency; (2) hyper-acute; (3) acute stroke unit; (4) early supported discharge (ESD) and community rehabilitation; (5) life after stroke and longer-term support.

England (NHS)

Pre-hospital: stroke patients go to a 24/7 specialist service within an integrated stroke delivery network (ISDN). Source: NHS England National Stroke Service Model, May 2021, Part 1 overview. Status: overview checked; pre-hospital section not read in full.

Hyper-acute: scanning, thrombolysis and thrombectomy in 24/7 networked services. The model cites a 5% relative reduction in 90-day mortality with networked hyper-acute stroke unit (HASU) configurations (overview, citing references 3 and 4). It also says imaging and interpretation should happen "within 60 minutes of arrival" (hyper-acute section, around line 766 of the cached text). Status: the 60-minute wording is in the model, but I did not read the surrounding clause to confirm it is a target rather than a standard for a sub-group. Maddy's summary said "60-minute imaging target"; the model's wording supports the 60-minute figure, not the word "target".

Acute stroke unit: continuous specialist care, with assessment by all specialist therapists, including speech and language therapy (SLT), "within 24 hours of admission" (model, acute care section). Status: verified against the model text. The flowchart cited NICE NG236 recommendations 1.1.2 and 1.1.3 for the core MDT; I did not re-read NICE in this session, so that citation is carried over from the flowchart draft and is not re-verified here.

ESD and integrated community stroke service (ICSS): "Early Supported Discharge (ESD) must be available in all areas" (model, section 6.2). Each area should provide community rehabilitation through an ICSS, a multidisciplinary team (model, section 6.2). Patients eligible for ESD should be assessed and treated in the community within 24 hours (model, section 6.2). The model says the ICSS model "will be published in full in due course". Length: the model says the course "equates, on average, to six months. However, this is neither a target nor a ceiling" (section 6.2). The flowchart's "up to six months" wording overstates this; the correct description is an average for service planning.

Life after stroke and longer-term support: rehabilitation depends on "integrated working between the NHS, social care and the voluntary sector" (model, rehabilitation in the community). The model also refers to life after stroke support in section 07. Status: the principle is verified; ILASS (the specific life after stroke service name in Maddy's summary) is not verified from the text I read.

ISDNs: each ISDN should be "based on between one and four ICSs" (model, Part 1, ISDN establishment). Count of ISDNs not verified.

Non-NHS: social care (local authority) and voluntary sector sit alongside the NHS at stages 4 and 5. The model names the voluntary sector as a partner in ISDN governance and rehabilitation but does not specify provider names.

Scotland

  • Acute stage (1 to 3): the Scottish progressive stroke pathway (gov.scot) sets acute standards. Seen in search extracts only, not read in full. Snippets state that people with communication problems after stroke should be assessed by a speech and language therapist, and that acute therapy assessment should happen by day three of admission (FOI release of a Scottish stroke pathway document, 2022 reference). Status: partly verified. The day-three figure comes from a FOI-released document and needs checking against the primary pathway text.
  • Rehabilitation (4 and 5): the progressive stroke pathway (section 11) says rehabilitation in hospital should occur in an integrated stroke unit or specialist rehabilitation area, that the inpatient team includes SLT, and that people identified with a communication disorder should be assessed by a SLT and given an individualised programme (section 11.1.3 and 11.1.5). Status: seen in search extract, not read in full.
  • Structure: health boards (NHS) run acute services. Community and social care are delivered through integration authorities (health and social care partnerships, HSCPs). Source: Maddy's summary and gov.scot National Advisory Board page (inactive). Status: partly checked.
  • Framework: the Scottish Framework for Supporting People through Recovery and Rehabilitation (2020) is cited as the live reference. The gov.scot URL I tried returned 404, so the Framework text is not confirmed. Do not present it as read.
  • Non-NHS communication support: the Volunteer Stroke Service is reported to operate across about 90% of Scotland, in partnership with local SLT services (Better Heart Disease and Stroke Care Action Plan, paragraph 5.45, seen in search extract). That plan is older and undated in the extract, so treat the 90% figure as unverified for today.

Wales

Pre-hospital and emergency: suspected stroke should be directed to emergency services via 999 (NHS Wales Standards, section 3.3). Status: verified from the Standards text.

Hyper-acute and acute (0 to 72 hours): CT within 20 minutes of arrival; thrombolysis within 30 minutes of arrival where clinically indicated (Standards, section 3.4). Occupational therapy and physiotherapy assessment within 24 hours. A swallow assessment by a specialist such as an SLT within 24 hours if swallowing is impaired. "A speech and language therapy assessment of speech, language and communication needs within 72 hours of arrival" (Standards, section 3.4). Status: verified against the Standards text (Version 1, October 2025).

Acute staffing (RCSLT 2026): the Standards recommend a minimum of 0.48 FTE SLT per 5 beds in a seven-day model. Only one of six health boards providing acute SLT met this; the other five averaged a 37% shortfall. No service offered a seven-day model. Status: verified against the RCSLT report (January to March 2026 data collection). This is an independent benchmarking exercise, not a government audit; it is a source disagreement or gap, not a contradiction of the Standards.

Rehabilitation (4): the Standards recommend 0.56 FTE SLT per 5 beds in rehabilitation. RCSLT 2026 reports an average shortfall of 44% across seven health boards. Status: as above.

ESD and ICSS: the Standards recommend 0.4 FTE SLT per 100 patients per year for ESD in a seven-day model. RCSLT 2026 reports only three of seven health boards meeting it, with an average 50% shortfall in the other four. Integrated Community Stroke Service (ICSS) is section 3.6 of the Standards. Status: staffing figures verified; ICSS service detail not read.

Life after stroke (5): the Standards say this section "is currently in development" and will be co-produced with stroke survivors and carers. Status: verified. Wales has no finished life after stroke standard as of October 2025.

Health boards and local authorities: the All Wales Rehabilitation Framework (Welsh Government, 2022) is cited. Maddy's summary says it sets a "stepped care model" with "WALES principles" at page 26. Status: not verified. The Quality Statement (February 2026) describes Comprehensive Regional Stroke Centres (CRSCs) as the focal point for hyper-acute care and rehabilitation in the first 72 hours, and places life after stroke as a core component alongside acute care. It does not mention a stepped care model in the text read.

Welsh-language provision: the Standards require services to promote bilingual care and state that "a proportion of the workforce should be able to deliver patient care and rehabilitation in the Welsh language". Verified.

Non-NHS: local authorities, third sector and voluntary organisations (Standards, glossary and section on life after stroke). Named bodies not verified.

Northern Ireland

Acute and hyper-acute: the Department of Health page describes Hyper Acute Stroke Units (HASUs) providing 24/7 support for the first three days, with Acute Stroke Units (ASUs) afterwards. A regional process to decide hyper-acute network locations was intended to identify preferred locations "by Summer 2025" (health-ni.gov.uk). Status: the page is not dated in the extract. Whether the locations were confirmed is not verified.

Rehabilitation and ESD: the Department of Health stroke pages say community stroke teams "have been expanded ... to provide Early Supported Discharge in all five Trusts" (online.hscni.net). Undated and possibly superseded. Status: partly verified. Five Health and Social Care Trusts (HSCTs) is consistent with this, but the page is not current.

Community: Northern Health and Social Care Trust (one trust page, undated) lists community stroke nursing, physiotherapy, occupational therapy, SLT, dietetics, psychology, social work and voluntary support. Most patients are offered a stroke review 6 to 8 weeks after discharge. Status: seen in search extract for one trust only. Not generalised to all NI trusts.

Structure: HSC Trusts combine health and social care in one tier, so the England split between NHS and social care does not apply in the same way. Source: Maddy's summary. Status: consistent with the trust naming but not checked against a primary structure document.

Dated NI sources: the 2012 DHSSPS stroke standards (DHS69528) set SLT assessment for communication disabilities within 7 days and a minimum of 2 hours SLT per week for those who are well and motivated. This is superseded by any current NI standard I have not found. Do not use the 2 hours figure as current.

Where sources disagree or leave gaps

England "20 ISDNs": not in the model text read. Leave open until the ISDN structure section is read.

England ICSS "up to six months": the model says "on average" and "neither a target nor a ceiling". The flowchart wording should change.

England "60-minute imaging": the model text supports "within 60 minutes of arrival" for imaging. The context was not fully read.

Wales SLT staffing: Standards (what should happen) and RCSLT 2026 benchmarking (what is happening) differ. Both are correct for their purpose; they answer different questions.

Wales stepped care and WALES principles: not found in the Quality Statement text read. Check the 2022 Rehabilitation Framework page 26 before using.

Scotland acute stage: sources are seen only in search snippets. Read the progressive stroke pathway full text before stating acute standards.

Scotland Framework: not confirmed live; the gov.scot URL returned 404.

Northern Ireland: current structure and hyper-acute network decision not confirmed; the sources found are undated or old.

Aphasia-specific provision

Maddy's summary did not separate aphasia-specific services from generic stroke rehabilitation. The model and standards refer to SLT across the pathway but name no aphasia-specific service. The Scottish pathway and the NI 2012 standards refer to communication disorder specifically. The Welsh Standards refer to communication needs. The brief does not map aphasia-specific provision by nation. This is an open decision for Maddy, as the flowchart draft also notes.

What is needed to finish

Read the England ISDN structure section and the hyper-acute section in full (the model is cached at ~/.hermes/cache/web/www.england.nhs.uk-b62f0cfbd3.md).

Read the Scottish progressive stroke pathway in full (gov.scot publication; acute and rehabilitation pages).

Find a current Scottish Framework URL (the 2020 publication page returned 404).

Find a current Northern Ireland acute-stage source and the status of the hyper-acute network decision.

Read the 2022 All Wales Rehabilitation Framework, page 26, to check the stepped care and WALES principles claim.

Sources (all dated as shown; retrieval 18 October 2026):

  • NHS England, National Stroke Service Model, Version 1.0, May 2021 (PAR406).
  • NHS Wales Performance and Improvement, NHS Wales National Stroke Service Standards, Version 1, October 2025.
  • Welsh Government, Quality Statement for Stroke, 4 February 2026.
  • RCSLT, State of the Nation Report 2026 (May 2026), stroke section.
  • gov.scot, Strokes: progressive stroke pathway (undated extract); National Advisory Board for Rehabilitation (inactive).
  • Department of Health NI, Hyperacute Stroke Care (undated extract); DHSSPS, Stroke Services DHS69528 (2012).
  • HSCNI, Reshaping Stroke Services in Northern Ireland (undated extract).
  • Northern HSC Trust, Emergency stroke treatment (undated extract).
  • NICE NG236, recommendations 1.1.1 to 1.1.3 (cited from the flowchart draft; not re-read in this session).