Bruins et al and the accompanying editorial on stroke care make a compelling case for reviewing conventional policy approaches to stroke, which often show a dysequilibrium towards the (very important) front end of stroke, and a relative agnosia for (equally important) aftercare.1 Although it is clearly very important that all should have access to stroke unit care (and thrombolysis for those for whom it is indicated), most patients will still have residual disability after both of these interventions and will be more prone to further strokes than the rest of the population. Comprehensive national audits of stroke care show alarming levels of neglect in terms of chronic disease management and seem to indicate a collective nihilism about the potential for altering function and wellbeing after the early treatment of stroke,2 despite evidence of the effectiveness of continuing therapy and support at long intervals after stroke