Ian Bowns

Implementation of case management in long-term conditions in England: Survey and case studies:

Objectives Our aim was to describe the current provision of case management arrangements in primary care for people with long-term conditions in England and identify the extent and nature of self-care support services within it. Methods Cross-sectional survey of primary care trusts (PCTs) in England and four case studies using semi-structured interviews and focus groups. Results Services were predominantly nurse-led, typically by community matrons, and delivered on a geographical basis. Often multiple arrangements existed within a PCT but integration of services with local authority adult social care was not widespread. A range of self-care support services were utilized and often tuition was provided by case managers to patients in their own homes. Assessment, care coordination and direct support to patients were the principal tasks. Often care plans were limited to primary care services and did not include service costings. Links with nurse-led services within PCTs were evident but operational links with adult social care were poorly developed. This is consistent with previous research relating to the introduction of care management in social services in England which also resulted in a plethora of organizational arrangements. Conclusions Case management for patients with long-term conditions is at an early stage of development. Effective links with a range of local services are required if care plans are going to be comprehensive.

Occupational therapy roles and responsibilities: Development of a standardised measure of time use for staff working with adults in community settings

Introduction This paper documents the development of a diary schedule to describe the work of occupational therapists of all grades, across a range of adult care groups and community health and social care settings, to permit comparison between them and over time. Method Two sources of information were used to develop the schedule: findings from five focus groups with occupational therapists (46 participants) and analysis of previous research on staff time use undertaken by the Personal Social Services Research Unit at the University of Manchester. It was piloted and evaluated by scrutiny of the schedules, a group interview with participants and meetings with managers. Results Practitioners identified almost 200 activities in their day-to-day work. These were categorised into three principal activity themes: direct care, indirect care and team or service development. The pilot study revealed ease of completion and discernible differences between settings and activities together with suggestions for improvement to the schedule regarding the description of activities and the accompanying guidance. Conclusion A diary schedule and common activity list, covering the full breadth of occupational therapy practice in adult community care, was developed. Whilst its utility in an organisation employing practitioners in multiple settings was demonstrated its wider applicability is unproven.

Occupational therapy roles and responsibilities: Evidence from a pilot study of time use in an integrated health and social care trust

Introduction Occupational therapists undertake a broad spectrum of activities, yet no mechanism exists to record how working time is distributed across them. This is a hindrance to research, evaluation and evidence-based practice. Method A new diary schedule was piloted by 151 qualified and assistant-grade practitioners working in multiple adult health and social care settings in an integrated NHS and social care trust in England. Time use relating to 37 occupational therapy tasks was recorded in 30 minute intervals for one week. Results Almost 5000 hours of activity were recorded. For the average working week, 39% of time was spent in direct care with clients, 31% involved undertaking indirect casework such as liaison and administration, whilst a further 22% was in team/service activity. Only modest differences were observed between qualified and assistant-grade respondents, whilst occupational therapists in traditional social care roles spent significantly longer in liaison and administrative duties. Individual tasks capturing ‘therapeutic activity’ accounted for just 10% of practitioner time. Conclusion The new diary tool is a viable data collection instrument to evaluate practice and the impact of service redesign. However, further work is needed to evaluate its measurement properties in more detail.