Stroke services in the UK are currently being overhauled in response to the UK government’s 2007 national stroke strategy.1 The strategy was developed after the National Audit Office (NAO) report on stroke services laid out the features of a first rate service and how improvements in the service could reduce death, disability, and recurrent stroke along with costs.2 The strategy highlights markers of a quality service (box) that are entirely appropriate. However, possibly inaccurate estimates of clinical benefits and cost savings in the NAO report may have influenced subsequent plans for stroke services.3 4 These have a strong emphasis on hyperacute stroke care (the first 72 hours) and on greatly increasing the proportion of patients being given intravenous thrombolysis, but with the risk that the many other effective components of a comprehensive stroke service might not receive as much attention. The stroke strategy for London is a good example.5