• health and social care interface;
  • people’s experiences of stroke;
  • Pilot Community Stroke Service (PCSS);
  • pluralistic evaluation;
  • System Induced Setbacks

The aim of the present study was to explore the experience of stroke survivors and their informal carers of stroke services in the community, as part of a pluralistic evaluation of a Pilot Community Stroke Service (PCSS) in Nottingham, England. The research design involved qualitative in-depth interviews with four main stakeholder groups in the evaluation, in combination with analyses of varied data sources, including participant observational and documentary. In addition to interviews with 57 stroke survivors and their carers (as appropriate), interviews were conducted with the team of the PCSS, individually and as a group, and with a range of other workers. The pluralistic approach of the evaluation revealed that tensions and social conflicts at the interface between services, and particularly between health and social care services, had a negative impact on the quality of life of clients and carers alike, which were experienced as ‘setbacks’, and which could be shown to be system induced. Such ‘System Induced Setbacks’ also had negative consequences for the team of the PCSS, since rather than being a ‘top up’ service, in such cases it became a ‘mop up’ service, compensating for the shortfall in service provision. Thus its aims and objectives could not be fully realized. It was concluded that pluralistic evaluation had a number of strengths including that, because of its attention to process and social context, it revealed the existence of System Induced Setbacks and their negative and long-term impact on the daily lives of clients and carers, and on the team of the PCSS, in a way which would not have been possible had a quantitative approach been used.