Senedd Cymru | Welsh Parliament
Y Pwyllgor Cyllid | Finance Committee
Cyllideb Ddrafft Llywodraeth Cymru 2025-26 | Welsh Government Draft Budget 2025-26
Ymateb gan: Y Gymdeithas Strôc | Evidence from: Stroke Association
You do not need to answer every question, only those on which you wish to share information or have a view.
The draft budget is expected to address ongoing financial pressures faced by the third sector, including the aftermath of the COVID-19 pandemic and the cost of living crisis. However, there are concerns about whether the support provided will be sufficient to meet the increasing demand for services. Many organisations are already experiencing financial strain and operational challenges, as is outlined in the response to the budget consultation from WCVA.
The draft budget’s impact on people affected by stroke will depend on the specific allocations for health and social care services. The Welsh Government has previously committed to improving stroke care through initiatives like the Stroke Implementation Group and the development of comprehensive stroke centres. However, the extent of funding and support in the new budget will be crucial in determining the actual impact on stroke survivors and their carers and families.
If the budget does not adequately fund stroke services, there could be negative impacts on stroke survivors, including reduced access to rehabilitation and support services. The financial pressures on the health sector might lead to longer waiting times and limited resources for stroke care. Ensuring sufficient funding for these services is essential to avoid such negative outcomes.
Please outline your reasons for your answer to question 2 (we would be grateful if you could keep your answer to around 500 words).
The Stroke Association is the only charity in the UK providing lifelong support for all stroke survivors and their families. We provide tailored support to thousands of stroke survivors in Wales each year. This support includes one-to-one and group support, funding vital scientific research into stroke prevention, acute treatment, recovery and long-term care, and campaigning to secure the best care for everyone affected by stroke.
We
are commissioned by five of the seven Local Health Boards in Wales
to provide Life After Stroke Services. In 2023/2024, these services
supported around 2,500 people.
Over the past decade, funding for stroke services has not kept pace
with inflation, forcing us to reduce services. While some funding
has been redirected to prevention, which led to our very successful
project with Carmarthenshire Council, it remains crucial to support
people who do still go on to experience a stroke in their longer
term physical and mental recovery. The need to ensure resource for
this is urgent as the NHS Executive plans to transform stroke
services nationwide. Funding concerns risk focusing only on acute
care, but comprehensive care, including life after stroke, is
essential. Our research with Health and Care Research Wales shows
that life after stroke services are cost-effective. Therefore,
investing in the entire stroke pathway should be a priority for the
remainder of the Senedd term and included in the Programme for
Government for 2026-2030 to improve stroke performance, which has
declined since 2019.
Currently, we face uncertainty as contracts end, with no communication about future funding. Poor communication and engagement from commissioners with our organisation and people affected by stroke, combined with funding pressures and the cost of living crisis, threaten our charity’s ability to secure long-term contracts and retain skilled staff. If we cannot support those people, they will end up elsewhere in the health and social care system.
Our Life after Stroke Support Coordinators provide a lifeline for survivors and their loved ones trying to make sense of the new and terrifying post-stroke world, one in which they might otherwise feel isolated and alone. They provide vital, one-to-one support that stroke survivors and their families need along their recovery journey. They work to understand each stroke survivor’s individual needs, so they can tailor support to what matters most. They help survivors to make sense of the advice of medical staff and understand their diagnosis and medication. They support and encourage survivors to commit to their rehab therapy and provide the crucial emotional support that is so often needed after the trauma of a stroke. With the wider family in mind, our Stroke Support Coordinators help to address worries about money and getting around, and provide guidance on issues such as rights at work and carer support. Stroke Support Coordinators also have extensive experience and knowledge of the health and social care service. That means they can navigate complex systems and advocate on behalf of stroke survivors and their families. They can also connect them with local services that provide additional support to help survivors and their families through the long and emotional journey to recovery.
We also have an
additional range of Stroke Association Support Services that we
provide from our own funding. This includes 44 groups in the Stroke
Group Network. Five are Stroke Association Support Groups, and 39
are independently run by volunteers, many of whom are stroke
survivors themselves.
Our Stroke Support Helpline is the only national helpline for all
stroke survivors and their loved ones. Last year alone, we
responded to over 19,000 enquiries. When a stroke happens, our
Stroke Support Helpline listens to and answers people’s
immediate questions, helping to calm their fears. One call to our
Stroke Support Helpline also opens up a world of wider support. It
connects survivors and their families to other stroke support
services such as our Stroke Support Coordinators, peer-to-peer and
group support, as well as local community services that might be
helpful throughout the recovery journey.
§ help households cope with inflation and cost of living issues;
§ address the needs of people living in urban, post-industrial and rural communities, including building affordable housing and in supporting economies within those communities?
(We would be grateful if you could keep your answer to around 500 words).
A cross-sector collaboration and action plan is needed to tackle inequalities in Wales. Areas once seen as affluent are seeing increasing levels of poverty. The Government should address, both existing levels of deprivation and ensure prevention of other areas falling into this. It is widely understood that stroke is more prevalent in areas of deprivation. In 2023, Healthcare Inspectorate Wales recommended that health boards implement targeted stroke prevention and awareness campaigns to those from black and minority ethnic background and those living in areas of lower socio-economic deprivation and that this should run alongside the FAST / CAM NESA campaign. In the summer of 2024, we reached out to all health boards in Wales to understand what progress had been made on this. Only three health boards responded to us and we have seen none of these campaigns across Wales, despite the evidenced benefits for prevention and awareness. Meanwhile, we have anecdotal evidence from hospitals that says people are turning up to A&E not recognising that they have experienced a stroke. Latest NHS Executive evidence shows that between 2021 and 2022, there is a 16% pan Wales increase in self-presenters to A&E who had experienced a stroke. The Welsh Government can improve the lives of people across Wales equitably, it should look to ensure that Public Health Wales funds and runs a regular FAST/CAM NESA campaign in Wales and that health boards run targeted stroke prevention and awareness campaigns. The funding and resource to do this is essential and must be aligned with the plans to transform stroke services.
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In
2024, the Stroke Association in Wales held roundtables and a
questionnaire with stroke survivors, their carers and families and
people who work. This is to ensure our influencing work reflects
what people affected by stroke think needs to happen for stroke
provision. The work will also help to shape our manifesto ahead of
the Senedd 2026 election.
One of the points made on a number of occasions was the difficulty
in returning to work.
Through our direct contact and support given to people affected by stroke, we hear that there are a variety of challenges can make it difficult for people who experience a stroke to return to work, leading to prolonged periods of unemployment or underemployment. Stroke survivors often face significant physical limitations, such as weakness, fatigue, and mobility issues, as well as cognitive impairments like memory loss, difficulty concentrating, and slower processing speeds. The emotional toll of a stroke, including anxiety, depression, and changes in mood, can further hinder a survivor’s ability to re-enter the workforce. This can exacerbate feelings of isolation and reduce overall quality of life. Inability to return to work can lead to significant financial strain, increasing the risk of income poverty. This can affect not only the stroke survivor but also their family, as they may need to provide additional care and support.
The Welsh Government can invest in comprehensive stroke care that includes acute treatment, rehabilitation, and long-term support. This ensures that stroke survivors receive the necessary care to recover and reintegrate into society through investment in life after stroke services. On top of this, Welsh Government could look into implementing vocational rehabilitation programs can help stroke survivors return to work by providing job training, workplace modifications, and support in finding suitable employment.
Increased public awareness about the challenges faced by stroke survivors and the importance of inclusive workplaces is needed to help reduce stigma and encourage employers to provide necessary accommodations. This relates to both the physical impact but also the emotional impact of what a stroke survivor has experienced. Mental health support, provided by someone who understands stroke and the impact it can cause is an important part of someone’s recovery that is currently missing from the stroke pathway. Our recent work on Rebuilding Minds After Stroke explores this further.
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Effective collaboration with the not-for-profit sector in Wales is crucial, as it plays an essential role in society. By working together more closely, we can pool resources, empower those affected by issues to shape services through their input, and ensure that spending is efficient and impactful. This collaboration should go beyond surveys and consultations, creating real opportunities for joint decision-making. Funding decisions should then be transparently communicated to the public.
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No, the financial and political pressures on health boards in particular have led to staff being moved onto other work, away from stroke. This has led to a lot of uncertainty for the work to transform stroke services and turnaround performance and outcomes in stroke. There is a lack of joined up working to coordinate this huge piece of work. HEIW needs to engage and be actively involved in planning WITH those working on the transformation plans. So far, this has not happened. It needs a task force to get momentum on the whole work going again. The Stroke Association are happy to support this to work.
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This is currently not clear and as part of the not-for-profit sector, the Stroke Association could support with this. We currently do this as part of our engagement with Senedd Members, Welsh Government, NHS Executive, wider NHS and Public Health Wales. However, much of this is from our own efforts and we feel the Welsh Government would benefit from reaching out and collaborating more closely with the not-for-profit sector to better understand what is affecting people’s lives and therefore more effectively understand what resources are needed where.
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No. This funding is often given to health boards and councils to decide to commission services. This leads to variations in services. We have huge problems getting engagement and involvement from those in charge of this funding to fully understand what they are funding and the benefits and to know what is happening as funding ends. The current setup of annual funding does not help this. For some services. A centralised funding allocation system (such as through the Joint Commissioning Committee) may be more beneficial for everyone involved.
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