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23 April 2009: Despite many improvements in stroke services over the past decade, a quarter of patients in the National Sentinel Audit for Stroke 2008 were not offered the best treatment for stroke, a stay in a dedicated stroke unit.

The audit, funded by the Healthcare Quality Improvement Partnership (HQIP), was carried out on behalf of the Intercollegiate Stroke Group by the Royal College of Physicians' Clinical Effectiveness and Evaluation Unit (CEEu), and covers 100% of eligible hospitals in England Wales and Northern Ireland. Individual hospital results will be available on the College website from 10.00 am on Thursday 23 April.

Other significant findings from this round of the audit include:

• 29% of patients were admitted to a stroke unit on the same day as their stroke and 57% were admitted either the same day or the following day. This is a major improvement since 2006
• 74% of patients now spend some of their time and 68% spend more than half their time on a stroke unit which is a very considerable improvement from 2006
• Only 17% of patients are admitted to an acute stroke unit within four hours of admission
• Use of the FAST Test (Face, Arm, Speech Test) by ambulance staff was recorded in only about a quarter of patients' notes
• Only 21% of patients had a brain scan within 3 hours where appropriate, an improvement over the last audit (16% in 2006) but nowhere near high enough if patients are to receive the best outcomes
• Over a quarter of patients were not screened for swallowing difficulties within 24 hours, 20% have no record of visual field testing and 15% no record of sensory testing
• Marked improvements have been achieved in the last two years in speed of assessment by therapists after admission. While far from perfect it is clear that a major effort has been made to improve the quality of care being provided nationally
• Although increasing numbers of centres are providing a thrombolysis (anti blood-clotting drug), less than 10% of appropriate patients are receiving the drug nationally. However, service developments are likely to result in an increase in this percentage in coming years
• There has been consistent improvement in performance in the nine key indicators in England over recent years, perhaps reflecting the value of a strong national stroke strategy in driving service improvements.

A worrying number of patients are being moved into nursing homes directly from hospital. 2%, or 82 out of 4432 patients discharged within two weeks of a stroke were admitted to care or residential homes. In many parts of the country access to intensive rehabilitation in care homes is limited or non-existent and these patients could be deprived of effective rehabilitation in the quick transfer to a nursing home. Patients who are likely to require residential care in the future still deserve a period of treatment to enable them to live as full and active life as possible.

Dr Tony Rudd, Chair of the Intercollegiate Stroke Network, said:
"Since the last time we looked at quality of stroke care two years ago there have been some very gratifying improvements. However services remain patchy and in some parts of the country the chances of getting good care is low. I am optimistic that now we have started implementing the National Stroke Strategy these inequalities will lessen and we will have stroke care that is the envy of the world."

Robin Burgess, Chief Executive of HQIP, said:
"Despite improvements already made, this audit has really highlighted the need to continue to address the shortfalls in care. As shown in many HQIP commissioned national clinical audits, implementation of good practice helps to save lives and we strongly urge both clinicians and managers to review practice and ensure recommendations are being acted upon."

Joe Korner, Director of Communications at the Stroke Association, said:
"This is the first audit since the National Stroke Strategy was launched and demonstrates that really encouraging improvements are being made in stroke care. But it also reveals areas where a lot of work is needed for stroke services to reach the quality markers set out in the National Stroke Strategy. This audit is a wake up call: we need to see acceleration in the progress that is being made, and a step change in those areas which are still not providing the quality of treatment that everyone who has a stroke deserves."

Professor Roger Boyle, National Director for Heart Disease and Stroke said:
"I welcome this latest Audit which provides an authoritative insight into stroke services in the NHS. The national stroke strategy is a ten-year plan, and there are no simplistic quick-fixes to the improvements we want to see - there is still a long way to go. But, by making stroke a number one priority for the NHS, providing extra funding and establishing the Stroke Improvement Programme and local stroke networks, we are now firmly aiming at the revolution in stroke services over the next few years that we all want to see."

For more information, or to view the full report, click here.

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