Many stroke patients are still not spending enough of their hospital stay on a specialist stroke unit or having a brain scan within 24 hours, a National Audit Office report has revealed.

The report, published this week, says the proportion of stroke patients spending more than 90 per cent of their hospital stay on a stroke unit has increased from 51 per cent in 2006 to 59 per cent in 2008. But this still falls short of the national target of 60 per cent.

It is worth revisiting the incentives in the emergency system so that services are measured on the basis of the best outcomes

It adds that although 59 per cent of applicable stroke patients were given a brain scan within 24 hours in 2008 - an increase from 42 per cent in 2006 - access to this service at weekends and evenings is “significantly more limited”.

The findings chime with an investigation by HSJ last year which found that fewer than 40 per cent of acute and specialist trusts were meeting the required standards on stroke care in the Care Quality Commission annual health check.

Analysis of the CQC ratings found just 37 per cent of the 150 acute and specialist trusts measured achieved the stroke target.

NAO director of health and report co-author Karen Taylor said although there have been improvements, not all issues in stroke care had “yet been addressed by any means”.

She told HSJ: “In acute care, there are still wide variations in the response to stroke, the time spent on stroke units and access to scans.”

She added: “Commissioners should be looking at how they are spending [existing] resources and where that money could be better spent. Some of it would be in better rehabilitation services.”

NHS Confederation policy director Nigel Edwards said: “To move everyone up to the standard of the best, it is worth revisiting the incentives in the emergency system so that services are measured on the basis of the best outcomes and clinical processes for patients rather than only ambulance response and emergency department waiting times.

“Improving many services will also require an acceptance from both the public and local politicians that providing better care may well include making tough decisions on how services are arranged locally.”