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There have been few initiatives in primary care as thoroughly researched as intermediate care in England (e.g. see Godfrey et al. 2005, Cornes et al. 2007). This is explicable for a number of reasons. Firstly, the service is new; secondly, central insistence and target setting have encouraged it; and thirdly, it arrived at a time when finding out ‘what works’ was in theory central to health service policy making and management. Finally, the unique localism of intermediate care, where each model is different and continually evolving, means that this has made national generalizations difficult and of limited applicability.

Many of these elements are evident in Nancarrow's article (2007). She identifies, for example, that the two case study sites chosen for this research had intermediate care services that are very different in scale, approach, location and goals. In this study, she focuses on staff and their work, drawing on a wider discussion elsewhere that would provide useful contextual data (Nancarrow 2004) for readers who are seeking further opportunities to reflect on the implications of role redesign.

At one level, the lessons from this research are highly confirmatory of the process of change. The data show that staff find intermediate care work highly satisfying. This is not simply good for them, but likely to benefit service users. The work enabled them to exercise their skills, to gain a sense of control over their tasks (even if this could be stressful) and made clinical and managerial responsibilities and leadership relevant to patient care. Not surprisingly, nurses when interviewed were encouraged by this new type of work and the scope it provided for personal and professional fulfillment.

However, intermediate care is a joint endeavour and reflects many elements of ‘modernized’ health care. This means that, while the job satisfaction of nurses may clearly be an important consideration, their work has an impact on close colleagues who are often not professionally trained and may not be part of the health service. This is why I would be more cautious about depicting intermediate care teams as non-hierarchical. While nurses may share some tasks with social-care colleagues and work collegially in their company, there is a hierarchy of power, pay and professionalism. This may be seen in the reflections of some of the nurses in this study that care work was not for them.

I am not arguing that social care needs to take on more nursing tasks. As the recent inspection of hospital discharge arrangements for older people (Commission for Social Care Inspection 2005) reveals, there is much room for nurses to move back into the area of care as well as rehabilitation of vulnerable older people at home. This work is also likely to be satisfying: a good recruitment advertizement.

This theme of job satisfaction is one which Nancarrow develops in this article. She suggests that the nurses’ satisfaction is intermediate care stemmed from the content of the work itself and the quality of relationships within the team. Further work might usefully make more of standardized measurements around subjects such as work/team environment to look more closely at trends over time. The interviews undertaken in this study also provide examples of themes that might be interrogated further. These include attitudes to working at night, how to manage the delicacies of working in people's own homes, and how to interpret the extent to which family members want to be part of the ‘care team’.

For human resources staff and workforce development interest groups this article throws down a challenge. What is the career potential for such staff? How can we retain staff who value personal contact with service users/patients and who expect a higher level of reward as their experience grows? How can the work of nurses be evaluated to see if outcomes for patients are being met, when there is a range of different inputs? As Nancarrow notes, career development opportunities are important for this group of skilled and experienced nurses. It would be interesting to see where these early pioneers of intermediate care continue to practice.

The study here is of two different teams, both working in intermediate care and addressing one of the key questions for the National Health Service (NHS): who is it, who will implement the numerous policy changes of a health-care system that would still be fairly easily recognizable to Nightingale, or at least the architects of the NHS? The ageing population of the UK is not a sudden arrival, but only recently have some real shifts in the workforce begun to respond to this. Professional training often still fails to recognize that virtually everyone will need to be expert in the care and treatment of older people.

References

  1. Top of page
  2. References
  • Commission for Social Care Inspection (2005) Leaving Hospital. CSCI, London.
  • Cornes M, Manthorpe J, Watson R & Andrews J (2007) Someone to expect every day. Help The Aged, London.
  • Godfrey M, Keen J, Hardy B, Townsend J, Moore J, Ware T, West R & Weatherley H (2005) An Evaluation of Intermediate Care for Older People. University of Leeds, Leeds.
  • Nancarrow S (2004) Dynamic role boundaries in intermediate care. Journal of Interprofessional Care 18, 141150.
  • Nancarrow S (2007) The impact of intermediate care services on job satisfaction, skills and career development opportunities. Journal of Clinical Nursing 16, 12221229.