Ending abandonment after stroke: how can Wales deliver better recovery beyond hospital?

Introduction

Stroke is one of the leading causes of disability in Wales and affects around 7,000 people each year. While survival rates continue to improve, many people experience a significant reduction in support once they leave hospital at a stage when rehabilitation remains critical to recovery and long-term independence. Around 45% of stroke survivors report feeling abandoned following discharge because they do not receive the support they need to recover well.

The impact extends far beyond the individual. Variations in access to rehabilitation, follow-up support and community services can lead to poorer outcomes, increased carer burden, avoidable demand on health and care services, and significant societal and economic costs. Stroke currently costs NHS Wales approximately £220 million per year and the wider Welsh economy approximately £1.63 billion annually. Without intervention, these costs are expected to increase significantly.

The challenge has been developed following extensive investigation across Wales involving clinicians, health boards, national leaders, stroke survivors, carers and the Stroke Association. This work has helped define the challenge, identify unmet needs, understand existing service variation and explore the current market landscape. The conclusion is clear: Wales requires innovative, scalable approaches that can strengthen recovery, improve experience, reduce feelings of abandonment and support more equitable outcomes beyond hospital discharge.

The challenge aligns with the Welsh Government Quality Statement for Stroke, which places renewed emphasis on rehabilitation, recovery, person-centred care and ensuring that stroke survivors do not feel abandoned during their recovery journey.

The Challenge

We are seeking innovative solutions that can improve rehabilitation, recovery and long-term support for stroke survivors.

Access to rehabilitation and follow-up support varies across Wales. As a result, outcomes can depend too heavily on where a person lives rather than on their clinical need. This challenge seeks innovative approaches that can improve equity of access and help ensure people can receive high-quality rehabilitation and recovery support regardless of geography, including those living in rural, remote, underserved and seldom heard communities across Wales.

The challenge is outcome-focused and does not prescribe a specific technology, product type or delivery model.

Applicants are encouraged to propose the approach they believe will best address the challenge and demonstrate how their solution could be adapted, developed or enhanced to meet the needs of NHS Wales and stroke survivors.

We are not seeking to specify a single solution in advance. The purpose of this challenge is to support the development, demonstration and evaluation of innovative approaches that can improve recovery, reduce feelings of abandonment and create foundations for sustainable improvement across Wales.

Particular consideration should be given to how solutions can improve access to rehabilitation and recovery support for people who may face barriers associated with geography, transport, service availability, digital exclusion, workforce capacity or being within a seldom-heard group.

The challenge is not simply about providing more therapy. We are interested in approaches that enable personalised, continuous and motivating rehabilitation and self-management support across home, community and outpatient settings whilst supporting better experiences and outcomes for stroke survivors.

Desired Outcomes

We are interested in solutions that can deliver measurable improvements in one or more of the following areas.

Recovery and Independence

• Improved functional recovery and rehabilitation outcomes.
• Increased independence and ability to participate in everyday life.
• Improved confidence and self-management.
• Better long-term health and wellbeing.

Patient and Carer Experience

• Reduced feelings of abandonment following discharge from hospital.
• Improved quality of life and emotional wellbeing.
• Better support for families and carers.
• More person-centred rehabilitation and recovery services.
• Improved patient experience.

Service Delivery and Equity

• Reduced unwarranted variation in access to rehabilitation support.
• More consistent experiences across Wales.
• Improved access to rehabilitation and recovery support for people living in rural and remote communities.
• Reduced geographic variation in access to services.
• More equitable outcomes regardless of location.
• Improved continuity of care and follow-up.
• Better coordination across services and organisations.

System Outcomes

• Reduced avoidable demand on health and care services.
• Better use of workforce capacity.
• Improved operational intelligence and service planning.
• Stronger evidence to support future adoption and scaling.
• Improved understanding and measurement of outcomes.

Sustainability

• Affordable and scalable approaches.
• Long-term sustainability beyond the funded project period.
• A realistic route to adoption across Wales.
• Creation of capability that can support future service development.

Applicants should clearly identify which outcomes their solution is expected to influence and explain how impact will be measured.

Phase 2: Development and Real-World Demonstration

This challenge is being delivered as a Phase 2 Contracts for Innovation competition.

In contrast to a Phase 1 competition, focusing on feasibility, we are seeking organisations with existing technologies, products, platforms, services or rehabilitation approaches that require adaptation, enhancement, configuration or further development to address the identified needs of stroke survivors, carers and rehabilitation services across Wales.

This challenge follows significant investigation and engagement to understand the problem, review evidence, define requirements and explore potential market solutions. We are therefore seeking solutions with an established foundation. Early-stage concepts requiring fundamental research or proof-of-concept development are unlikely to be supported

Projects should support the development, adaptation and real-world demonstration of innovative approaches capable of improving rehabilitation, recovery and life after stroke.

Successful projects are expected to generate practical evidence relating to:

• Patient and carer outcomes.
• Rehabilitation outcomes.
• User experience.
• Service and workforce impact.
• Affordability and sustainability.
• Adoption readiness.
• Future scalability.

Applicants should describe in-detail:

• What they propose to deliver.
• How it will be tested and evaluated.
• How impact will be measured.
• How the solution could evolve in future.
• A core delivery plan to 31 March 2027, including activities, milestones, deliverables and costs.

Applicants should describe in outline:

• A separate proposal for a potential further stage beyond April 2027, including the additional activities, deliverables, outcomes, milestones, timescales and costs.
• How the further stage would build on the evidence and learning generated during the core project.
• What additional value the further stage would deliver for stroke survivors, services and the wider recovery pathway.
• How the core project would remain viable and deliver meaningful outputs if further funding does not become available.

Development Approach

NHS Wales is interested in solutions capable of delivering practical benefit within the project period whilst creating foundations for longer-term improvement.

Projects may initially focus on specific aspects of the rehabilitation and recovery pathway and then be refined through deployment, user feedback, evaluation and service learning.

The expectation is not that applicants will solve every aspect of stroke rehabilitation within a single project. Rather, we are seeking practical solutions capable of demonstrating measurable value whilst creating opportunities for wider transformation over time.

Future Capability and Scalability

We are particularly interested in solutions that can create sustainable capability and learning for NHS Wales. Applicants should describe how their solution could evolve over time and support wider adoption where appropriate.

Applicants should demonstrate how their solution could be deployed at scale across Wales, including in rural, remote and geographically dispersed communities, whilst maintaining a consistent user experience and quality of support.

Whilst the immediate focus of this challenge is stroke rehabilitation and recovery, solutions that demonstrate potential for future transferability to other settings or services may be advantageous.

Collaboration and Partnership

Collaboration will be fundamental to the success of this challenge.

Successful applicants should expect to work closely with NHS Wales organisations, clinicians, rehabilitation teams, operational staff, people with lived experience, carers and relevant third-sector organisations throughout the project lifecycle.

The Stroke Association is expected to play an important role in challenge development and delivery. This includes support for service design, requirement development, access to lived experience, engagement activities, testing, evaluation and dissemination. The Stroke Association has also indicated potential interest in supporting future project development subject to budget approval and where solutions align with the organisation’s strategic priority; to tackle the devastation of stroke.

The Stroke Association believes every stroke survivor should be supported to make their best possible recovery, so they can move beyond simply surviving a stroke to finding their way back to life. You can read more about the Stroke Association’s strategy at: https://www.stroke.org.uk/about-us/corporate-strategy

Applicants should clearly demonstrate:

• Their approach to stakeholder engagement.
• How lived experience will inform development and evaluation.
• How they will collaborate with challenge partners.
• How they will support implementation and adoption.
• How they would specifically support long-term emotional support for stroke survivors and reduce feelings of abandonment.
• How their project aligns to the Stroke Association’s strategic focus.

Meaningful co-design with stroke survivors will be considered an important component of successful projects.

Welsh Language Requirements

Wales is a bilingual nation and Welsh language considerations must form an integral part of solution design. Applicants should consider Welsh language, accessibility and equitable access together throughout the design process, recognising the diverse needs of stroke survivors across urban, rural and remote communities in Wales.

Any successful solution containing patient-facing, public-facing or user-facing functionality must include both Welsh and English provision as part of the Phase 2 development activity.

Applicants must demonstrate how their solution will:

• Support bilingual service delivery.
• Ensure Welsh and English users receive an equivalent experience.
• Be bilingual by design rather than relying on translation as a later enhancement.
• Support people to interact in their preferred language.
• Provide communications and content in Welsh and English.
• Support the principles of the Active Offer.
• Consider Welsh language and accessibility requirements together throughout design, testing and implementation.
• Include Welsh-speaking users where appropriate in testing and evaluation activities.

Welsh language functionality should be embedded from project inception and must not be treated as a future enhancement or optional module.

Where solutions incorporate automation, artificial intelligence or advanced digital functionality, applicants should explain how Welsh language provision will be supported and maintained as the solution evolves.

Applicants may find the following resources useful:

• Welsh Government Bilingual Technology Toolkit for a Good User Experience.
• Accessible Communication and Information Standards for Healthcare.

Solutions incorporating wider multilingual capability are also encouraged where this supports accessibility and inclusion, provided Welsh and English provision remains fully supported.

In Scope

We are interested in solutions that contribute to emotional and psychological support, as well as one or more of the following:

• Stroke rehabilitation and recovery.
• Community neurorehabilitation.
• Self-management and independence.
• Continuity of care following discharge.
• Patient engagement and motivation.
• Family and carer support.
• Outcome measurement and recovery tracking.
• Service coordination and pathway management.
• Digital rehabilitation technologies.
• Assistive technologies.
• Artificial intelligence and digital innovation.
• Remote rehabilitation and support models.
• Rehabilitation planning and personalisation.
• Welsh language and bilingual service delivery.
• Reducing feelings of abandonment after stroke.

Out of Scope

We are not seeking projects that:

• Focus primarily on acute stroke diagnosis or treatment.
• Focus solely on stroke prevention.
• Focus solely on one specific aspect of physical rehabilitation, such as upper limb therapy or foot drop.[AT1] 
• Require extensive fundamental research before development can begin.
• Are primarily academic research studies without a credible route to implementation.
• Cannot demonstrate an existing technology, service or evidence foundation.
• Cannot demonstrate a realistic route to adoption within NHS Wales.
• Rely on English-only user-facing delivery.
• Seek to replace appropriate clinical judgement or professional oversight.
• Focus solely on data collection without a clear route to improving rehabilitation outcomes.

Affordability, Sustainability and Adoption

Affordability and sustainability are central requirements of this challenge.

Applicants should demonstrate:

• Affordability beyond the funded project period.
• A realistic route to adoption within NHS Wales.
• Scalability across Wales.
• Opportunities to improve outcomes and service efficiency.
• Long-term sustainability.
• Ability to operate effectively across both urban and rural settings.
• The overall value proposition for NHS Wales.
• Alignment with the Stroke Association’s strategic priority.

Solutions should demonstrate how they could transition into sustainable operational delivery if proven successful.

Wider Benefits for Wales

Applicants are encouraged to consider wider benefits their proposal may deliver for Wales.

These may include:

• Supporting people to remain independent and economically active.
• Enabling more people to return to work or daily activities following stroke.
• Supporting carers and families.
• Reducing inequalities in access to rehabilitation.
• Developing skills, capability and innovation within Wales.
• Supporting bilingual innovation.
• Creating wider social, economic or community benefits.

Funding Allocation and Project Details

Competition Type: Phase 2 Development and Real-World Demonstration

Funding Available: £300,000

Number of Projects: To be confirmed

Portfolio Approach

Funding decisions may be made using a portfolio approach, recognising that improving recovery and reducing abandonment after stroke is a complex challenge that may benefit from multiple complementary solutions rather than a single intervention.

Consideration may be given to the overall balance of projects supported, the evidence generated, opportunities for collaboration between projects and the potential for wider adoption and learning across Wales.

Solutions may address different aspects of rehabilitation, self-management, recovery, service coordination, family support, accessibility, digital capability, assistive technology, data, analytics or outcomes measurement. Collectively, these may contribute towards the wider ambition of improving life after stroke across Wales.

Potential further funding: Additional funding may become available to support a further stage of development or demonstration beyond April 2027. This funding is not currently confirmed and should not be assumed as part of the initial project award. Any decision to provide further funding would be subject to funding availability, project performance, evidence of value and the priorities of the challenge partners.

Project Duration

Projects are expected to commence in November 2026 and conclude by 31^st March 2027.

Projects may include an initial period on solution configuration, adaptation, integration and preparation for deployment, followed by real-world testing, evaluation, learning and (UKRI-130522-SBRIDrivingPublicSectorInnovation-FINAL.Pdf, n.d.)refinement.

The initial funded project period is expected to conclude by 31 March 2027. Subject to additional funding becoming available, satisfactory progress and the value demonstrated during the initial project period, consideration may be given to extending selected projects beyond April 2027.

Applicants should include a clearly defined proposal for this potential further stage, setting out the additional activities, deliverables, outcomes, milestones, timescales and costs. This should be presented separately from the core project proposal and should explain how the further stage would build on, rather than duplicate, the work completed during the initial funded period.

Any extension and associated funding are not guaranteed and would be subject to funding availability, project performance, evidence of value and separate agreement. Applications must therefore demonstrate that the core project remains viable and delivers meaningful outputs by 31 March 2027, regardless of whether the further stage proceeds.

Applicants should provide a realistic delivery plan, including key milestones, testing activities, evaluation approaches and anticipated outputs.

Key Dates

Briefing Event

To register for the virtual Briefing Event, to be held online on the 2nd October, please follow the link below:

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Once this date has passed, you may access the Briefing Event recording here:

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Application Process

Directions on how to enter this competition can be found via: https://sdi.click/abandonment-after-stroke-1

Key Dates

Long-Term Vision

The ambition of this challenge is not simply to introduce new rehabilitation tools or technologies.

The longer-term opportunity is to create a more connected, equitable and sustainable approach to rehabilitation and recovery in Wales, ensuring that stroke survivors can access appropriate support, achieve the best possible outcomes and do not feel abandoned during their recovery journey, regardless of where they live.

The strongest applications will demonstrate practical short-term impact whilst creating foundations for wider transformation across rehabilitation and recovery services in Wales.

 [AT1]To be reviewed to ensure this addition is not limiting potential solutions.