A new audit has found that fewer than one in 15 stroke survivors across England, Wales and Northern Ireland get the amount of rehab they’re meant to. These perfomance stats just seem to getting worse and worse in direct correlation to increasing public money given to the NHS to improve performance. Now ARNI reads that only 6.4% of patients got the recommended three hours of therapy a day, at least five days a week in the first quarter of 2026. This is down from 7.5% at the end of 2024. Average therapy time dropped too, from 46 minutes a day to 40. The figures come from the Sentinel Stroke National Audit Programme (SSNAP), the national audit run out of King’s College London that tracks the whole stroke pathway.
The spread between hospitals is wide. SSNAP’s own data puts the national median at about 40.5 minutes of therapy a day, but the lowest-reporting services managed just 15.2 minutes of therapy daily while the best reached 57.3 minutes – so depending on where you happen to be admitted, your daily therapy can vary nearly fourfold. And of course we find that once survivors get home again, only 68% of them get any continuing rehab support at all, even though two-thirds are now discharged to a stroke-specific community service on paper!
Even the therapy that does get delivered is often the wrong kind. The recommendation is written in minutes, and minutes are a poor way to measure what actually drives recovery. What rewires the brain after a stroke is intensive, repetitive, task-specific practice; you making the movement, over and over, with real intent (the evidence on this is strong and consistent across every phase after stroke btw). One well-known study found that in typical physio and OT sessions, stroke patients managed a median of just 32 upper-limb reps. The dose actually shown to stimulate neuroplasticity is several hundred a day; the animal thresholds sit around 400, and human studies point to somewhere in the 300 to 600 range.
A long session full of passive mobilisation and rest can fail to even cross the threshold needed to trigger the plasticity cascade, while a shorter, properly active session clears it easily. In other words, you can get your ‘minutes’ and still get almost nothing out of them if the session’s passive. Being moved isn’t the same as moving. Passive therapy – things done to you rather than by you – has been shown again and again to do very little for neuroplasticity.
So I think this audit exposes two problems: the first is obviously way too little therapy given – a resourcing issue for the NHS. The second is that a large part of what IS delivered is far too passive and too low-rep to drive any real/ meaningful/significant recovery..
The annual cost of stroke to the UK is now put at £25.7bn, most of it long-term social care and lost income, so getting recovery right is absolutely critical. This is where the third sector, like ARNI, comes in. With over 100 qualified instructors across the UK, ARNI exists to teach stroke survivors how to train actively, in their own homes, at the kind of intensity and repetition the evidence actually calls for, long after NHS therapy has tailed off. Being coached, pushed and supported to do repetitive, task-specific work yourself (rather than passive ‘treatment’ being administered onto/unto you), which is the only thing the brain really responds to.
The SSNAP figures show a service slipping backwards; less therapy, fewer people supported after discharge, and wide variation by location. Counting minutes is pointless too = we all know that the evidence shows that largely passive therapy does little for recovery however much of it you get; but what is shown to be much more helpful is active, high-repetition work by survivors themselves, facilitated, guided & guarded by therapists and trainers – bringing in family members and friends to assist & encourage where/when professionals can’t be present
