Thousands of stroke patients are dying each year due to a lack of specialist care, experts have warned.
Stroke disability and death can be reduced by fast treatment
The National Sentinel Audit of stroke services in England, Wales and Northern Ireland said improvements had been seen in recent years.
But it found over 40% of patients were not given a brain scan within 24 hours of admission, as they should be.
In addition, 60% did not spend the majority of their hospital stay in a specialist unit.
The Audit includes data for 8,697 patients treated in the 203 trusts in England, Wales and Northern Ireland.
WE WAITED FIVE HOURS
John Honour was sent to hospital by his GP after having two mini-strokes.
He and his wife Susie waited in A&E for five hours - during which time John had a two more mini-strokes.
It was only when he had a full stroke that he was found a bed.
John, now 59, was left permanently disabled by the stroke, which occurred six years ago.
He is paralysed on his right-hand side and still has trouble speaking and writing.
His wife Susie is angry that he was not assessed as soon as he got to casualty.
She said: "People must have scans immediately, so treatment can begin and so damage can be minimised."
In England and Wales alone, 130,000 people have a stroke each year - a third are likely to die within 10 days.
But experts estimate 5,000 die due to a lack of specialist care.
The audit, carried out by the Royal College of Physicians between April and June 2004, found 54% of patients did not receive such specialist care.
Eighty-two per cent of trusts now have a specialist unit compared to 74% in 2001.
And 41 trusts had no stroke unit at all.
The government had set a target for 100% of trusts to have a stroke unit by April 2004.
Patients are also missing out on vital tests, the audit showed.
TOP FIVE TRUSTS
North Wiltshire and Devizes Area Stroke Unit
Royal Free Hampstead NHS Trust
South Manchester University Hospitals NHS Trust
Sperrin Lakeland Health and Social Care Hospital Trust
St Mary's NHS Trust
Certain patients can have their risk of mortality and disability reduced if they are given aspirin within 48 hours.
But the audit found only a third of this group were given the drug.
The experts behind the audit say this is partially explained by stroke not being considered a medical emergency, resulting in delays in brain scanning that would highlight people who would most benefit from the treatment.
And a third of patients were not having their ability to swallow assessed.
Trusts were given a score out of 100 based on standards such as time spent in a specialist stroke unit, access to emergency brain scans and rehabilitation services.
The average score across all hospitals was 61, but in some trusts scores were in the low 30s or even under 30.
Dr Tony Rudd, Chair of the Intercollegiate Stroke Network, said: "For those hospitals that have not made major improvements, the audit will help identify areas for change, and gives a very clear strategy for building first-class stroke services.
BOTTOM FIVE TRUSTS
United Lincolnshire Hospitals NHS Trust
Pennine Acute Hospitals NHS Trust
Mater Hospital Belfast HSS Trust
Mid Devon Primary Care Trust
"To support this, we need government to make stroke a major priority."
Anna Walker, Chief Executive of the Healthcare Commission, which funded the audit, said: "It is very encouraging that the provision of stroke care has improved, however the audit does show there is a significant amount of work to be done."
Jon Barrick, Chief Executive of the Stroke Association, said the audit showed that, despite "real progress" having been made in recent years, there were still unacceptable delays in diagnosis and a lack of specialist treatment.
He added: "Patients are still waiting to be promptly diagnosed and to
have immediate access to specialist staff.
"We are all still waiting for stroke to be made the medical priority that it should be.
"This is scandalous when you consider that it is the third biggest killer and the biggest cause of long-term disability."
Professor Ian Philp, National Clinical Director for Older People's Health said: "Record levels of investment have been already been made in the NHS and this audit shows dramatic improvements in specialist stroke care.
"Death rates are falling and people are going home from hospital a full week faster than before.
"We have raised the numbers of hospitals that treat stroke with specialist units from 45% in 1998 to its current rate of 91% and expect to be at 100% by the end of April 2005."
But he said: "We know that there is much more work to be done."