Stroke disease is associated with considerable morbidity and mortality. In the UK an estimated 150 000 people suffer from stroke each year and stroke is the third most common cause of death in England and Wales after heart disease and cancer.1 In Ireland there are approximately 10 000 acute strokes annually and it is estimated that there are 30 000 people living with disability post stroke. The population of people over 65 years is set to increase (15% of population over 65 by 2021) and total stroke costs in 2021 are estimated to increase by 50% in comparison with 2007. This increase in the number of people suffering from strokes will place additional pressure on an already over-burdened healthcare system. In these economically challenging times it is crucial that stroke care is delivered in an efficient and cost effective manner. Stroke care alone contributes between 2% and 4% to the total health budget; of which 40% is spent on nursing home care. Improvements in the acute delivery of stroke care and rehabilitation could have a significant impact by reducing the number of nursing home placements.2 In the UK National Sentinel Stroke Audit 2006 a stroke unit was defined as a multidisciplinary team including specialist nursing staff based in a discrete ward that has been designated for stroke patients.3 Studies evaluating stroke units in the 1960s in the UK showed that they did not meet their primary outcome measure of decreased mortality for stroke patients. Thus many evolved as rehabilitation units or were subsumed into another ward.4,5 In 1993 Langhorne et al. 6 looked at all randomized control trials on stroke unit care between 1962 and 1993 and found that there was a significant reduction in mortality for patients treated in stroke units versus care on general wards. …