An estimated 6,000 people die unnecessarily every year in the UK because of a lack of specialist stroke care, research suggests.
An audit of stroke care carried out by the Royal College of Physicians found that although there had been progress in some areas of care, most hospitals still have a long way to go.
At the present rate of change, the report says it would take up to 73 years for every stroke patient to spend most of their hospital stay in a dedicated stroke unit.
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People are dying unnecessarily and living with long-term disability
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Dr Tony Rudd
Stroke is one of the UK's biggest killers and the single main cause of severe disability. Each year 130,000 people have a stroke.
The survey found that lack of resources were to blame for problems with facilities, diagnosis, treatment and care.
It also found 27% of stroke patients spent most of their stay in a stroke unit compared to 25% in 1999 - that is an increase of 1% per year.
If that continues, it will be 73 years before all patients with a stroke spend half their hospital time in a dedicated stroke unit.
The survey also showed that only 36% of stroke patients spent any time at all in a stroke unit despite evidence that patients fare better in specialist facilities.
Physical assessments
Only 64% of patients were recorded as having a swallowing assessment, only 63% a visual fields assessment, and only 49% being weighed.
Without this information, the patient is unlikely to be offered appropriate therapy, such as speech or language therapy or physiotherapy.
This may lead to future problems in regaining the use of their limbs, sight, hearing and ability to eat properly.
Other findings include:
The number of hospitals who treat stroke patients in a stroke unit has increased from 45% in 1998 and 56% in 1999 to 73% in 2001/2, but the number of allocated beds remains inadequate and cannot meet the demand
Nearly one in five patients are not getting a brain scan
One in ten patients who should be prescribed aspirin or similar drugs following their stay in hospital is not receiving them
The number of Trusts who have a consultant with responsibility for stroke has gone up to 80%, but the majority of doctors doing this only spend about eight hours of their week in this role.
The British Association of Stroke Physicians estimates an average district should have two full-time stroke physicians.
Dr Tony Rudd, a stroke specialist at Guy's and St Thomas' Hospital in London, said evidence suggested that 19% fewer people would die and 29% fewer would end up dead or disabled if they were treated in a specialist stroke unit.
That amounted to about 6,000 more people dying, or a total of 12,500 left dead
or disabled, every year in the UK.
He said: "People are dying unnecessarily and living with long-term disability, some of which could have been avoided, because of the failure to deliver specialist stroke care.
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Stroke care is moving forward but at a snail's pace
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Margaret Goose
"Co-ordinated care saves lives and reduces disability.
"Although we are seeing improvements in stroke care, we are not going to achieve the ideal until stroke care is given a higher priority. We need more resources, staff, money and support to deliver effective stroke care."
More needed
Margaret Goose, chief executive of the Stroke Association, said she was "really disappointed" that nearly three quarters of stroke patients were not getting care in specialist stroke units.
She said: "Stroke care is moving forward but at a snail's pace.
"And while the improvement in care edges forward people are dying when they should not be or suffering from disability when they could be living independent lives."
The government's national service framework for older people stated that everyone who had a stroke should receive specialist care by 2004.
A Department of Health spokeswoman said: "The audit provides sound evidence that improvements are being made
and patients are benefiting from more effective stroke care."
The audit covered England, Wales and Northern Ireland.
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