Good quality continuing care requires the integrated, imaginative input of many professions and professionals combined with alert, perceptive, strong leadership. This leadership means motivating all those in the unit to achieve the agreed aims. It may come from doctors, administrators or members of the rehabilitation professions, but perhaps, most appropriately, from the nursing profession. This is because nurses have such a strong, close working relationship with the patients - and without good nursing care all else fails. That leader should have a proven track record of recognizing patients’ social and physical needs, and must persuade those closely involved with the patients to adopt a more open, questioning, flexible, self critical approach to care. Custodial styles of care, with a suffocating emphasis on safety at all costs , must be avoided since they induce total dependency by effectively smothering any form of independence. It should be possible to define a philosophy of care which improves standards of practice and methods of working. Change can be achieved as the contributors, and the case studies show.