1. All UK governments must urgently progress or commit to –​ national stroke initiatives, and deliver commitments made prior to the pandemic, acknowledging that stroke is one of the biggest health challenges of our time, and the damaging effects of the pandemic on stroke survivors.

2. All stroke rehabilitation must meet national clinical guideline levels, to mitigate the disruption to recoveries caused by the pandemic, addressing the individual needs of stroke survivors and maximising their potential for recovery.

3. Stroke teams should follow up with all stroke survivors who had a stroke this year to review and address their recovery needs, to avoid a 'forgotten' cohort of patients caused by the pandemic.

4. Health and care systems should involve stroke survivors and professionals in evaluating all changes to the stroke pathway in response to Covid-19, using the pandemic as a catalyst for positive change and mitigating any negative impact on people affected by stroke.

5. Health and care systems and local authorities should prioritise increasing the provision of, and access to, mental health services, to respond to the significant demand and unmet mental health and wellbeing needs of people affected by stroke, exacerbated by Covid-19.

6. Governments and local authorities must provide adequate support to carers to help them to cope with the additional pressures of Covid-19, supporting them to take regular breaks and maintain their wellbeing.

7. Stroke must be prioritised when research is restarted. Non-Covid-19 stroke studies should be at level two in the National Institute for Health Research's Restart Framework, defined as studies providing access to life-preserving or life-extending treatment. Future research should also explore the possible link between Covid-19 and stroke.

8. All UK governments should commit to investing in Act FAST public health messaging, given its success as a behaviour change intervention and particularly in preparation for any future surge in Covid-19 cases.

  • NHS England and Improvement must prioritise stroke commitments in the Long Term Plan, to mitigate against stroke survivors being further negatively impacted by the pandemic and to make sure that stroke care in England continues to make the progress it needs to.

  • ISDNs should work with people affected by stroke and other system partners to deliver on commitments in the National Stroke Programme in local areas and enable stroke services to meet the national clinical guidelines for stroke.

  • The Scottish Government must make urgent progress on its 2019-20 and 2020-21 Programme for Government stroke commitments:
    - Define [and implement] a progressive stroke service, covering the full pathway, including rehabilitation and long-term support.
    - Improve stroke care bundle performance in hospitals.
    - Increase awareness of the signs of stroke, and stroke prevention.
    - Make thrombectomy available for everyone who needs it by 2023.

  • The Scottish Government should establish a regular reporting mechanism for the Programme for Government stroke commitments to Parliament, to track progress on commitments, ensuring transparency and accountability.

  • The Welsh Government should replace the Stroke Delivery Plan when it expires with a new national plan for stroke, with hyperacute stroke units as its priority, in order to drive improvement across the stroke pathway.

  • As part of developing a new plan for stroke, the Welsh Government should develop national standards for stroke rehabilitation, as well as prioritising increasing the provision of, and access to, mental health services for stroke survivors. Local health boards should also ensure they have short- and medium-term plans for improving rehabilitation services in their local area while reconfiguration is ongoing.

The Department of Health and Northern Ireland Executive should stand by commitments they made before the pandemic and urgently:

  • Roll-out a new, regional long-term support pathway, which is appropriately funded to meet the needs of people affected by stroke. In particular, the new pathway should address the following issues which have been exacerbated by the pandemic:
    - The provision of the right rehabilitation support for people when and where they need it and for as long as they need it.
    - Increased investment in psychological and emotional support services for people affected by stroke.
    - Enhanced support for carers to take regular breaks and maintain their wellbeing, as well as a legal recognition of the vital role they play in our health and social care system.

  • Progress with the planned reform of stroke services to create a sustainable and high-quality service for everyone affected by stroke in Northern Ireland.