Targets missed, diagnoses delayed, and basic assessments not done. That is the sorry picture of stroke care revealed by the results of the Royal College of Physicians' (RCP) Sentinel Stroke Audit, according to The Stroke Association.

Whilst the standard of care has improved nationally progress is still too slow and the Audit reveals that many local discrepancies exist. For a substantial proportion of patients fundamental elements of care are not being received. Government targets, set four years ago, and clinical recommendations for the treatment of stroke are not being met.

Results from the audit, the largest ever examination into care provided to stroke patients by NHS Trusts throughout England, Wales and Northern Ireland, highlight a concerning number of issues in the current treatment of stroke around the country.

Specialist stroke unit treatment is still an exception rather than the rule. Stroke units save lives, improve outcomes and enable people to leave hospital quicker, thus freeing up resources and beds that can be redirected elsewhere. Yet despite their overwhelming benefits, 54% of patients did not receive such care and 60% did not spend the majority of their stay in a stroke unit. This means the government's target for specialised stroke care has not been met, and patients are missing out on vital care.

Brain scans are vital to enable accurate diagnosis of stroke and to start essential treatment. However the reports highlight dangerous delays in this process, with 53% of suspected stroke patients waiting over 48 hours to receive a brain scan. This indicates yet another area where government directives are still waiting to be met even though the deadline for reaching them has passed.

Aspirin is widely prescribed to prevent first or further strokes in at-risk patients. A third of patients who were eligible for aspirin had not been started on treatment by 48 hours after their stroke, despite it being a key clinical recommendation. 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.

Swallowing problems affect a third of people with stroke and can increase the risk of choking and coughing, and in serious cases may lead to chest infections and pneumonia. It was of 'grave concern' in the report that a third of patients are not having their ability to swallow assessed.

"Standards in stroke care have vastly improved over the past twenty years thanks to the concerted efforts of health professionals on the ground and a real commitment from government." commented Jon Barrick, Chief Executive of The Stroke Association.

"However it is extremely disappointing to see patients across the country are still waiting to get the essential care that they should receive according to government-set standards. How can the government possibly achieve their target of reducing deaths from stroke by 40% by 2010 if hospitals are not given the essential resources and support to achieve this? By getting this right, lives could be saved.

"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. It is staggering that something as basic as prompt diagnosis and treatment still needs to be highlighted and addressed.

"Someone has a stroke every five minutes in the UK . Its effects are devastating and often long-lasting. Poor funding and organisation of existing resources as well as inadequate staffing levels mean that health professionals are powerless to administer the level of care that they would like, and that patients deserve."

(15/3/05)