title: Commissioning vocational rehabilitation after stroke: Can the Cinderella services get to the ball? A qualitative study.
abstract: OBJECTIVE
  To understand the barriers and enablers to commissioning vocational rehabilitation (VR) after stroke.
  
  
  METHODS
  Interviews with health and social care commissioners responsible for stroke services across three counties were conducted to explore their views on the barriers and enablers to commissioning VR. Transcripts were subjected to thematic analysis, and validity checked with members of the research team.
  
  
  RESULTS
  The findings indicate that health commissioners have had to focus on demand-led and expensive acute stroke services, leaving little resource for community services. Though the benefits of VR to patient health are acknowledged, any cost savings would not be realized within the health budget. Social care commissioners, in times of budget restriction, focus on the most vulnerable, aiming to maintain independence and reduce care home admission. In the absence of evidence, there is a perception that the need for VR after stroke is relatively minor.
  
  
  CONCLUSIONS
  Factors which might facilitate commissioning of a VR service include adapting the service to align with commissioners' requirements, making VR a targeted outcome of community stroke services, utilizing emerging opportunities for joint health and social care commissioning such as Health and Wellbeing Boards, and closer working with researchers to improve the evidence-base.
authors.affiliation: Associate Professor in Rehabilitation Research (Long Term Conditions), Division of Rehabilitation and Ageing, University of Nottingham, UK Kate.Radford@nottingham.ac.uk.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Radford
authors.affiliation: Research Fellow, Collaboration for Leadership in Applied Health Research and Care - Nottinghamshire, Derbyshire and Lincolnshire (NIHR CLAHRC NDL), Institute of Mental Health, University of Nottingham, UK.
authors.forename: Amanda
authors.initials: A
authors.lastname: Crompton
authors.affiliation: CLAHRC Research Fellow, Institute of Mental Health, University of Nottingham, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Stainer
mesh_terms: D006760:Hospitalization; D006801:Humans; D036301:Qualitative Research; D012050:Rehabilitation, Vocational; D020521:Stroke; D000071939:Stroke Rehabilitation
keywords: commissioning; stroke rehabilitation; vocational rehabilitation