This study aimed to develop a comprehensive occupational therapy treatment schedule of upper limb interventions for stroke survivors with reduced upper limb function. Method: In a three-phased qualitative consensus study, 12 occupational therapists from acute and community settings in North West England contributed to interviews and subsequently group discussions to design and pilot a treatment schedule. Interview data were analysed using thematic analysis; the themes were used to develop a framework for the schedule that was supported by and reflected the International Classification of Functioning, Disability and Health framework. A draft schedule was the subject of a focus group and the resultant schedule was piloted in clinical practice by eight local occupational therapists working in neurological rehabilitation. Findings: Consensus was reached on three themes summarizing aspects of function: interventions that address preparation for activity, functional skills (that is, an aspect of function), and function. Three additional themes summarized other aspects of therapy: advice and education, practice outside therapy sessions, and psychosocial interventions. These themes became the main headings of the treatment schedule. The Occupational Therapy Stroke Arm and Hand Record treatment schedule was piloted and found to be comprehensive and potentially beneficial to clinical practice. Conclusion: The Occupational Therapy Stroke Arm and Hand Record treatment schedule provides a tool for use in stroke research and clinical practice.

Developments in primary and intermediate care services have enhanced interest in the notion of care management, the processes that it encompasses and the challenges that it poses to practitioners who are more used to working in a uni‐ or multidisciplinary manner. This article explores the way that a set of practitioners, new to care management, coped with the challenges of working within a newly created care‐managed assessment and rehabilitation service for older people in one UK county. Data were gathered via non‐participant observation, and group and individual interviews, as part of a wider action‐research evaluation study. Three themes emerged from the data: the processes of ‘learning’ to become a care manager; ‘doing’ care management; and ‘experiences’ of the role. In order to ‘learn’ care management, staff needed to develop a range of new skills, establish supportive care‐management processes, develop a new identity and work in an interdisciplinary way. ‘Doing’ care management involved working with a small group of patients with complex needs and precarious levels of homeostasis. Problem solving and crisis management were key activities and often required a creative approach to practice. Although care managers derived great satisfaction from their role, their ‘experiences’ were characterized by stress and anxiety. The practitioners from healthcare backgrounds needed more preparation to adapt to their new levels of responsibility and client risk. Successful management of the transition to care manager requires support from the key stakeholders and strong leadership within care manager teams. In‐house competency‐based training and induction programmes, and mentorship, can also play an important role, together with innovative forms of postqualifying education and training, for example, via job exchanges or an apprenticeship model.

Evaluation is an essential part of service development and quality management and this is especially pertinent when introducing new initiatives. In 2001 a new countywide assessment and rehabilitation Intermediate Care service, consisting of three care management Rehabilitation Link Teams (RLT), was implemented for older people. To monitor the implementation and impact of the service an evaluation study was conducted. The study centred on evaluating team development, interagency working, outcomes from multiple perspectives (client, carer, clinical and service) and the cost effectiveness of the service. Of particular importance to the study, however, was the action‐research approach that provided the underpinning philosophy to the study. This paper provides insight into the ways that the action‐research approach was used to facilitate learning and change within the organization. To enable this to happen, it was important for the health and social care staff to understand that the researchers’ role was not to judge their role proficiency, but to gather information to facilitate learning and understanding within the organization. It was also vital that the teams being evaluated were provided with regular insight into the emerging study findings and opportunity to address these. Three examples are provided to illustrate how regular information feedback sessions influenced the implementation of the service. Insight is also provided into the participant's views of being evaluated. Although at times, the RLT members found the evaluation burdensome, almost all stated that the action‐research approach allowed opportunity for reflection, catharsis and personal action planning. Overall, the action‐research approach to evaluation fitted well with the organization's need to learn and change simultaneously, allowing emergent data collection to inform decision making and service and team development.

Aims: The worldwide phenomenon of an ageing population has considerable consequences for health and health care; leading to greater demand for long-term care and support from families for older relatives. In the UK this, together with the preference for dependent older people to be cared for in the community, has led to the growth of intermediate care services (ICS) that bridge hospital and home offering rehabilitation and care. However, there has been limited in-depth exploration of carer perspectives of these services. This study therefore aimed to explore the impact of ICS on informal carers. Methods: An overview of UK Government policy on carers is provided to set the context. Qualitative semi-structured interviews, which explored participants’ lives as carers, their daily routine and what caring meant to them, were conducted with 19 informal carers within one ICS in north-west England. Findings: The ICS was not viewed in isolation; the impact of the ICS on the carer depended on previous experience and quality of health care, involvement in the decision making process, expectations and communication. Conclusions: A whole systems approach should be encouraged to increase awareness of carers’ experiences and the lasting impact negative experiences can have.

The purpose of this paper is to describe a qualitative oral history case study that involved consumers in research and followed a collaborative approach in the north-west of England. This study had two aims: (1) to increase local voluntary groups research capacity through active involvement in research; and (2) to explore the community's historical perceptions of health and well-being. The research team included four lay researchers from local voluntary groups supported by an academic researcher. Data collection used semistructured interviews based on oral history life stories that focused on health and wellbeing. Thematic data analysis and mind maps were used to create a collective narrative. This paper will provide a brief synopsis of the findings from the main themes of health and well-being, and reflect on the process of consumer involvement in research using oral history. Outputs have included dissemination at a local and national level, increased knowledge and confidence in the research process, and involvement in other related initiatives, such as Local Involvement Networks, partnership working with local libraries and collaboration with the regional archivist.