Question: The Stroke Association is launching its Why Are We Waiting? Campaign. What is it about?

Margaret Goose: It's the continuation of a campaign we've been at for some time which is basically about trying to make sure that there are specialist stroke services in all general hospitals in England.

Question: So why doesn't each NHS hospital have stroke wards with specialist staff?

Margaret Goose:Basically the National Standards said they had to be in April 2004, and this came out in March 2001.

And there have been national clinical guidelines out for a year before that, but some hospitals seem to have found it more difficult to get going than others.

Sometimes I think its because they don't have a lead stroke position. Sometimes it's a question of sorting out beds because these patients are in the hospital anyway - the idea is to get them grouped together in a geographically identified area with specialist trained staff.

At the moment, the last audit that was done showed that only 36 per cent of patients admitted to hospital for stroke get access at any time and only 27 per cent spend most of their time in a stroke unit.

So there's a long way to go.

Question: Is there a postcode lottery for stroke care?

Margaret Goose: From our perspective we find it difficult to understand.

We're looking after the patients anyway, in the hospital in different places and you know the evidence is that less people die and get disabled if they are looked after by specialists in a stroke unit so we want them to get on with it.

I think there are issues around the staffing and sometimes it may just be that other people aren't willing to change the nature of the beds.

Question: Is fast treatment vital for stroke patients?

Margaret Goose:It's not the most important thing. The evidence is stronger for stroke rehabilitation being done by specialist staff.

There is a feeling that in England, compared to Europe and the States, we don't treat stroke as an emergency. Therefore people don't get access to this kind of care quickly enough.

There is currently a drug being tested, with a restricted licence, but that is only going to help five to 10 per cent of patients. The organisation of care who is required to give it will help all patients.

So certainly we would like to see more emphasis given to acute care.

But you're not going to get good acute care unless you've actually got stroke specialists in hospital anyway.

So the trick for us is actually making sure there is a stroke specialist service in the hospital in the first place. There is no point getting people to hospital quickly unless there is back up there to treat them.

Question: What should be done to attract more specialist staff? Should they receive a better rate of pay?

Margaret Goose: No, when they are called "specialist staff" that means that they had training in stroke care.

Within each profession people tend to specialise and we're saying that people need training in stroke care rather than patients being looked after on a general medical world.

You need a team of people who are all trained in stroke care, in addition to doctors and nurses: the physiotherapists, the speech and language therapists and so on. Everyone needs to understand stroke. It's a combination of this teamwork rather than what individual people do that seems to be the most effective.

Question: Stroke seems to be less high on the public radar than cancer or heart disease for example. Would you agree?

Margaret Goose:Yes, we tend to think of stroke as the Cinderella and there are two reasons for this.

The first is the advent of CT screening. People didn't know whether stroke is caused by a block or a bleed so people thought nothing could be done and so patients tend to get ignored.

The other thing I suspect is age discrimination. The majority of strokes happen to older people and there is a bit of a Neolithic attitude. Its important to remind people that one in 10 strokes happen to people who are under 55 and that more women die of strokes than they do of breast cancer.

I also think that because there hasn't been a specialty of stroke positions, like there is a specialty of heart surgeons and cardiologists, stroke hasn't received the necessary attention.

People are also frightened of stroke. If people are asked if they would rather have a heart attack or stroke, most people would say heart attack as you either die or get better. With a stroke, a third will die, a third will get better and a third will be severely disabled. So people are actually quite frightened of it

We have obviously got to get the profile of stroke up. That's why we have done things with the Rotary clubs to get people's blood pressure checked - high blood pressure is a key trigger for stroke.