Patients who suffer strokes receive worse treatment in Britain than anywhere else in Western Europe.

More die and more are left disabled, a leading expert says in this week’s British Medical Journal, even though Britain spends as much as, if not more than, other countries on stroke care.

The gap is wide, according to Hugh Markus, of St George’s University of London medical school. One study showed that 15 to 30 per cent more stroke patients were left dead or disabled in Britain than in other countries.

Professor Markus identifies several possible reasons for the failure. European countries with better results tend to focus more on the care of patients immediately after a stroke, while in Britain the vast majority of money is spent on nursing and hospital overheads, and little on investigations or treatments.

Stroke care is a “Cinderella subject” in Britain, falling between neurology and general and geriatric medicine, he says, whereas elsewhere it is an integral part of neurology. This lack of interest may have led to underinvestment and, therefore, poor outcomes.

New treatments that can help patients to recover from a stroke make the failings even more significant. In strokes caused by clots blocking the blood supply to the brain (ischaemic strokes) the use of clot-busting drugs is effective, but patients must first be scanned to determine what sort of stroke they have suffered.

All hospitals have scanners, but struggle to scan stroke patients within 24 hours. For a patient to be treated with clot-busting drugs, the scan must be performed within three hours.

In many countries in Europe, and in North America and Australia, 20 to 30 per cent of patients get these drugs.

In Britain the figure is less than 1 per cent. Britain also treats fewer patients in dedicated stroke units than other countries, though setting up such units costs nothing and there is abundant evidence that they improve outcomes.

The audit by the Royal College of Physicians found that fewer than two thirds of stroke patients were treated in stroke units, and only a little more than half spent more than half of their stay in such a unit. The benefits include early rehabilitation, access to physiotherapy and staff experienced in stroke care.

Jim Whyte, who had a stroke ten years ago at the age of 55, spent 27 weeks in hospital - only the last five in a specialist unit. Mr Whyte, from Enfield, North London, was treated at Chase Farm Hospital. “Once I got into the specialist unit I had physiotherapy twice a day, speech therapy and training on how to manage for myself.”

The best help he gets these days, he says, comes from a local stroke club, whose members help one another with advice. He said: “That’s something the NHS didn’t think of. When I left hospital I was given nothing in the way of information, about how to avoid a second stroke, that sort of thing. Things may have got better since, but we’ve still got a long way to go.”

A significant challenge, Professor Markus says, is to change the perception of stroke among doctors and the public. Scanning units should be available 24 hours a day, and to achieve this regional specialist centres may be needed. Such changes have been achieved for heart care, so it is not impossible, he says, but it calls for commitment and a reorganisation of services, which have so far been lacking.

Joe Korner, director of communications at the Stroke Association, said that the present situation was unacceptable. “For many years the Stroke Association has been concerned about the UK’s poor record in stroke care compared to other countries,” he said. “That is why we have been campaigning hard to try to improve stroke services.

“The Government, with a new stroke strategy in development, has shown a commitment to improving the future of stroke care across the UK. But it is vital that stroke gets the priority and investment it needs.

“Without investment hundreds will die needlessly. Public awareness of stroke also needs to be increased so that people can recognise the warning signs.”

Dawn Primarolo, the Health Minister, said: “In the last ten years the treatment of stroke in the NHS has progressed rapidly - more patients than ever before are being seen by stroke specialists, numbers of stroke deaths are falling and advancing medical understanding gives every prospect for a real revolution in stroke treatment over the next few years.

“The National Stroke Strategy - setting out proposals for modernising stroke prevention, treatment and care - is currently out to consultation.

“It was developed with the Stroke Association and stroke survivors and carers, and was debated by Parliament. It follows £20 million invested in improved research into stroke and additional tools and support for hospitals on stroke prevention.

“Although we have more improvement to make to the numbers of people given clot-busting thrombo-lytic drugs, there are hospitals, such as King’s College, that are matching the best in the world.”

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