The independent healthcare watchdog is calling for improvements in the long-term care of stroke patients.
Stroke patients often need considerable rehabilitation
A Healthcare Commission survey of 850 patients found more were receiving specialist stroke care in hospital, and many were pleased with the results.
However, satisfaction levels with rehabilitation outside hospital dipped sharply in the year after discharge.
The government said it was working towards improving co-ordination between health and social care services.
Each year around 110,000 people in England have a stroke, and the condition causes 10% of all deaths.
Around half of stroke survivors are left dependent on others for everyday activities.
After-care is crucial to their ability to recover and subsequent quality of life. Over 850 stroke patients took part in the Healthcare Commission survey, which tracked the experience of patients from hospital through to their return home.
The survey found:
- 87% of respondents rated their care as excellent, very good or good on discharge - but only 66% did so one year on
- Just 12% rated their care as fair, poor or very poor on discharge - but a year or more later the figure was 34%
- 26% of those with speech problems said they had not had enough help from the NHS a year after leaving hospital - on discharge the figure was 16%
- 28% of people with mobility problems said they had not got the help they needed since leaving hospital - on discharge the figure was just 8%
- 49% of those who had emotional problems said they did not get sufficient help after leaving hospital - on discharge the figure was 25%
- 54% of those who said they needed home support did not receive the help they wanted
Anna Walker, chief executive of the Healthcare Commission, said: "We know that care in hospital for stroke patients is improving.
"However, the need for top quality care doesn't end when the patient leaves hospital.
"Stroke sufferers have told us that they need more rehabilitation and support - both emotional and physical - once they return home.
"It is vitally important that health and social services continue to work closely together to ensure that these individuals get the care and support they need and deserve."
Dr Tony Rudd, chairman of the Royal College of Physicians stroke working party and consultant stroke physician at Guy's and St Thomas Foundation NHS Trust, described the results as "disappointing".
"It reaffirms that we need to get stroke patients into properly managed, specialist stroke services, which are better equipped at co-ordinating after-care with community services."
Government guidelines, outlined in the National Service Framework for Older People, state that after a stroke, rehabilitation should continue until it is clear that maximum recovery has been achieved.
Joe Korner, of the Stroke Association, said the findings confirmed the "sorry state" of services for patients after they leave hospital.
He said: "The report demonstrates that the current strategies in place to support stroke patients once they leave hospital are failing too many stroke survivors. This must change."
Health Minister Rosie Winterton said a new stroke strategy was under development, and practical advice had been disseminated to the NHS on how to improve services.
"We are working towards better co-ordination between health and social care services and better support for carers.
"We are already increasing the numbers of staff needed to deliver these improvements."