18 October 2023
The RCSLT is concerned that this year’s two major stroke guidelines, the national clinical guideline for stroke and the NICE stroke rehabilitation in adults guidelines are not aligned.
UPDATE – The RCSLT have received further clarification on the concerns raised in this article. Please refer to our news story published on 2 November 2023 for updated details
This misalignment creates confusion for speech and language therapists who are providing vital and life-saving speech and language therapy to people after a stroke. Confusion risks people with communication and swallowing difficulties not receiving enough speech and language therapy to meet their ongoing needs.
The RCSLT is very worried that:
- There is a 3 hour therapy ambiguity. The move away from a 45 minute, daily therapy target per profession, to an overall 3 hour therapy target provides little information on what is specifically included. We are uncertain if the 3 hours includes all aspects of speech and language therapy, or just motor based therapy for example dysarthria, apraxia of speech and dysphagia therapy. We are uncertain how combined daily therapy hours will be allocated and counted. There is a risk that NHS Trusts could meet their 3-hour daily target without adequate speech and language therapy input.
- The communication screen has a difference in time frame. NICE is recommending within 72 hours, whilst the national clinical guideline for stroke recommends assessing people early after stroke for communication difficulties with no reference to a communication screen.
- NICE failed to name speech and language therapists as a qualified, trained dysphagia expert.
- NICE did not reference RCSLT’s eating and drinking with acknowledged risk guidance as good practice in supporting this complex decision making process
RCSLT action
The RCSLT is calling for urgent action in response to our concerns about the national clinical guideline for stroke and the NICE stroke rehabilitation in adults guidelines.
We have:
- written to the chair of the intercollegiate stroke working party (ICSWP) calling for clarity over the national clinical guideline for stroke speech and language therapy sections and our RCSLT ICSWP representations are working tirelessly to advocate for the profession and our service users
- fed back concerns to SSNAP over proposed changes to data collection tools
- written to NICE calling for help to translate this guidance into practice.
We are aware that the organisations behind the Guidelines take an evidence-based approach to their development, and that the intercollegiate stroke working party who develops the national clinical guideline for stroke also includes aspirational targets based on the evidence and professional consensus. The RCSLT has asked for urgent clarity from NICE and ICSWP on where the information differs, which guideline takes precedence and how speech and language therapists are meant to follow this.
We will keep our members informed with any further updates.
