Presupuesto de gastos de la actividad a realizar por la entidad beneficiaria.

Respondents

The respondents were all AHPs from each of the three professions represented in the team (OT, physiotherapy and SLT), or generic rehabilitation assistants. One quarter of the respondents were rehabilitation assistants. Whilst the team included psychologists, none responded.

The respondents ranged from bands 3-7 and were aged between 18-50 years old. Nine of the 12 respondents had worked in the team for more than 2 years and the remaining three had worked in the team for more than one year.

Perception of team type, role and function

The majority of the respondents described the team as multidisciplinary. Four respondents (AHP 1, AHP 2, AHP 7, and AHP 8) described the team as

interdisciplinary. Two of these were OTs. AHP 8 in addition to describing the team as multidisciplinary also described the team type as integrated and AHP 2, also added interdisciplinary to their response of multi-disciplinary. All respondents described the team’s function in a similar way with varying additional detail. Four of the respondents

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chose to identify the professions represented in the team in their answer. Three of these were rehabilitation assistants (RA). The rehabilitation assistants were the only ones to mention in their questionnaire responses the presence of psychologists in the team with RA 2 using the words: “with psychology input” (Team questionnaire 4,

question 1) and RA 3: “also psychology” team questionnaire 5, question 1). Surprisingly one of the team leaders (AHP 8) only identified the team being made up of speech and language therapists, OTs, physiotherapists and rehabilitation assistants.

Implementing and using Care Aims

Three members of the team (AHP 3, AHP 6 and AHP 9) reported that Care Aims was already being used when they joined the team. These three members of the team included all three AHP professions in the team and were all band 5 or 6 staff. The remaining respondents except RA 1 all identified that the team had attended formal Care Aims training and that the team had adapted the Care Aims paperwork for the team. Many of the responses described how Care Aims had facilitated setting realistic goals with patients and clarified roles and responsibilities during the rehabilitation process. Several gave negative responses about the length of time required to

complete Care Aims documentation. Several responses identified that Care Aims was used for their whole caseload with AHP 2 saying “this is integrated into our work so this is the norm” (respondent 11, q.12).

6.7.3 Results from Team Care Aims Interviews

The interviewees

Both the interviewees, AHP 1 and AHP 2 were band 7 and in leadership roles within the team. They were from different professions and both had worked in the team for more than 2 years.

Perception of team type, role and function

Responses to team type varied. AHP 1 described the team as an integrated team including OT, SLT, physiotherapy, rehabilitation assistants and psychology, referring later in her interview to the four disciplines in relation to goal setting. However AHP 2 only described the team as multidisciplinary working in an interdisciplinary way, referring to psychology once when describing how goals are set:

“goals are from each of the three disciplines or what or four if there’s something that involves the psychology aspect to it as well” (interviewee 2, p.9, line 13)

143 Both described the team’s function in a similar way.

Implementing and using Care Aims

Both AHP 1 and AHP 2 said that they felt using Care Aims was similar to how the team worked previously. Only AHP 2 described the formal training but both described how the team had thought about and adapted Care Aims for use within the team.

AHP 1 focussed particularly on how Care Aims was used to set goals and how it had helped the team to focus and think more about function rather than impairment. AHP 1 described how the team had worked together to set goals differently and that it had helped them clarify and manage expectations with patients.

AHP 1 described how challenging parts of the training had been particularly when thinking about her own caseload and identifying patients who potentially should not be on the caseload. Another challenge described was maintaining use of Care Aims when the service specification had changed and demand for the service increased. Care Aims was described as being used to inform triage but the Care Aims documentation was not as it was felt the team needed additional information to inform decision

making. AHP 1 described how the team used supervision and development workshops to explore how Care Aims was and could be used within the team.

AHP 2 described the impact of the formal Care Aims training for herself using phrases like “penny dropping” (interview 2, p. 2, line 23) and “waves of almost like adrenaline” (interview 2, p.2, line 24). AHP 2 also described how Care Aims had helped clarify expectations of patients and also for staff in terms of their role and duty of care. AHP 2 identified one of the challenges implementing Care Aims as being able to train new people who started work with the team after the formal training had been completed. Whilst the team has an informal programme, interviewee 2 felt it did not inspire new staff in the same way and their understanding of Care Aims was less than those who had completed the formal training.

Similar to AHP 1, AHP 2 described the professional dilemma of whether somebody should be on the caseload. The dilemma was different in that the issue was whose benefit goals were being set for: patient or family/carer. Whereas for AHP 1 it was the conundrum of very dependent disabled patients receiving less intervention than more able patients. Historically the most disabled patients would have received the most treatment irrespective of the change in impact of their disability on them. With the introduction of Care Aims impact became more significant. If a patient’s level of ability

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had changed very little and the impact of their condition was perceived to be low they would now receive very little if any intervention. A more able patient who had previously been fit and well but for whom the impact of their condition was greater would now receive more intervention. For AHP’s the dilemma was whether intervention was being sought to improve things for the patient or because carers wanted and/or expected intervention. AHP 2 also described how Care Aims could present cultural challenges in terms of expectations of health professional’s interventions and the role of the patient in participating in therapy.

Both AHP 1 and AHP 2 described the benefits of integrated goal setting for the

rehabilitation assistants and that had made their roles more manageable and that they were able to see more clearly why rehabilitation programmes were structured in a particular way. Both were also able to give examples of when they had used Care Aims with positive outcomes and indicated that the team would continue to use the Care Aims approach.

6.7.4 Results from the Patient Responses to the Care Aims Questionnaires

The patient response was completed by the patient’s carer. The role of the team was described as helping with rehabilitation to become more independent and to improve quality of life. The team was described as multi-disciplinary and consisting of

physiotherapist, occupational therapist, speech and language therapist, nurse, consultant and the GP.

The team were described by Patient 1 as being excellent “no matter what problem” they had had (question 4), particularly the nursing staff who continued to help although they were not directly involved with the patient anymore. They felt that care was effective because it was reassuring, reliable, gave them peace of mind and friendship (question 5).

The questions that asked for a less positive or less helpful situation or event were left unanswered.

The carer was able to clearly described what they hoped would happen as a result of assessment by the team. When asked how they felt about that now they responded “very good – as well as can be expected” (question 11).

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