The findings have been condemned as a "national disgrace" by the Stroke Association.

The Royal College of Physicians (RCP) compiled information from four out of five hospitals responsible for looking after stroke sufferers in England, Wales and Northern Ireland.

Only half of them had a specialist team for the treatment of strokes, which are among the most common reasons for admission to hospital.

And many failed to carry out key checks, or arrange the correct aftercare for patients.

The National Sentinel Audit for Stroke, which was commissioned by the body that manages the health service, the NHS Executive, spelled out a series of worrying statistics.

It found:

• Only 55% had their swallowing screened on admission
• Full vision examinations were performed in only 44% of cases
• Tests to check mental functioning were carried out in only 23% of cases
• Almost half did not have recovery and rehabilitation goals agreed by the team
• The needs of carers were assessed in only 31% of cases
• Only 49% of patients who went home had a review of disability six months later

Fewer than one in five patients spent more than half their time in hospital in the care of a specialist stroke unit, even though studies have shown that the right amount of specialist attention can significantly reduce future disability following a stroke.

'No excuse'

Dr Tony Rudd, associate director of the Clinical Effectiveness and Evaluation Unit of the RCP, said there was no longer "any excuse" to delay the creation of stroke units.

"Although some hospitals were performing well, the overall results were disappointing.

"The key findings from the audit support the establishment of stroke units of sufficient size to be able to treat most stroke patients admitted to hospital.

"They need not be costly to introduce and have been shown to save lives and improve functional ability."

Professor John Marshall, of the Stroke Association, said that stroke care still appeared to be "way down" the Department of Health's agenda.

"This review paints a picture of unacceptably poor stroke care. Most consultants, nurses and other health professionals are doing their best within the circumstances.

"But if more lives are to be saved, the system has to change and the government has to show that it cares about the elderly."

The association was particularly critical of the lack of swallowing assessment, or help with continence problems, which are common after a stroke.

The government is due to publish a set of national guidelines laying out the minimum standard of care a stroke patient can expect from the NHS.

The RCP believes that the audit will help shape these guidelines.