GRADUATE SCHOOL

SUBMISSION FORM for an ELECTRONIC THESIS (OR PORTFOLIO)

Title of thesis/portfolio:

Older people and hospital discharge: how service users’, carers’ and professionals’

experiences can inform social work practice.

Full name of Author: !Susan Margaret Fowler

Research undertaken in collaboration with: York Hospitals NHS Trust and City of York Council.

List up to five descriptive keywords or short phrases not in your thesis/portfolio title to help subject access once your electronic submission has been deposited to

Northumbria Research Link:

a) Older people and hospital social work

b) Older people and social care management

c) Delayed discharge

d) Delayed transfer of care

e) Multi-disciplinary work in hospital

I, Susan Margaret Fowler!!!!!!!!!!!! , the undersigned, claim

copyright of the above described thesis/portfolio (the “e-thesis”) and declare that:

• I am the author/co-author of the above described submission.

• No quotation from it or information from it may be published without my prior written

consent.

• The above described submission is my original work and does not, to the best of my

knowledge, infringe any third party copyright or other Intellectual Property Right.

• All necessary third party permissions have been granted before deposit.

• By submitting the above described submission to Northumbria Research Link I agree to

the Northumbria Research Link depositor/distribution licence (NRL LICENCE), and I also

agree to make my e-thesis available globally and via EThOS, the British Library UK Thesis Digitisation Project.

Signed: Susan M. Fowler

Date: 16 – 1 - 2012

OLDER PEOPLE AND HOSPITAL

DISCHARGE

How service users’, carers’ and professionals’ experiences can

inform social work practice

SUSAN MARGARET FOWLER

PhD

2009

! "

! #

OLDER PEOPLE AND HOSPITAL DISCHARGE

How service users’, carers’ and professionals’ experiences can

inform social work practice

SUSAN MARGARET FOWLER

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Thesis Abstract Older people and hospital discharge: how service users’, carers’ and

professional experiences can inform social work practice.

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Table Of Contents

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! G

Acknowledgements !

R&)(!1'('01;&!(%*-8!:0(!;4.-*;%'-!:)%&!3).0.;'!314,!0!6.)7'1()%8!43!941%&*,+1)0!

(%*-'.%(&)/!0:01-'-!+8!%&'!A;&442!43!B'02%&C!D4,,*.)%8!0.-!E-*;0%)4.!A%*-)'(Q!

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f)%&!<10%'3*2!%&0.@(!341!022!%&')1!/0%)'.%!<*)-0.;'C!).(/)10%)4.!0.-!V*(%!341!(%08).<!

:)%&!,'!J!%4!,8!(*/'17)(41(!0%!%&'!6.)7'1()%8!43!941%&*,+1)0T!

!

Professor David Stanley

!

Professor Jan Reed

!

$2(4!(/';)02!0//1';)0%)4.!%4!Danny Golding!341!&)(!.'7'1!30)2).<!/10;%);02!0.-!

',4%)4.02!&'2/!0.-!'.;4*10<','.%C!:)%&4*%!:&);&!%&)(!%&'()(!:4*2-!.4%!&07'!+''.!

:1)%%'.C!3).)(&'-!41!/14-*;'-!).!)%P(!3).02!341,Q!

!

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=1!?*(('22![*1108C!A*'!B'..'((8C!b0%8!^01%4.C!$20.!D201@'C!A*'!D0/'2C!g4!

$1,)(%'0-C!]41.0!b'..'-8!0.-!).!%&'!(%*-8!24;02)%8T!g40..'!B42,'(C!>0*2).'!

g4&.(4.!0.-!&'1!%'0,!0.-!all the service users, family members and the

professionals who gave their time so willingly.

!

!

!

!

!

!

!

!

!

!

This thesis is dedicated to my son Max and my parents Margaret and Colin Fowler

and is in memory of my Dad, Colin, who died in hospital in April 2007.

! WF

Author’s Declaration

I!-';201'!%&0%!%&'!:41@!;4.%0).'-!).!%&)(!%&'()(!&0(!.4%!+''.!(*+,)%%'-!341!0.8!4%&'1!

0:01-!0.-!%&0%!)%!)(!022!,8!4:.!:41@Q!

!

!

!

!

NameT!A*(0.![01<01'%!S4:2'1!

!

!

SignatureT!

!

!

DateT

! WW

W! Introduction to the thesis

WQW! Introduction

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!

1.3. Research aims

!

The project aims!:'1'!0(!34224:(T!

!

!! To explore how older people leaving hospital and their carers experienced the discharge process, focusing particularly on social work activity:

o! B4:!-)-!42-'1!/'4/2'!'L/'1)'.;'!;4,).<!).%4!0.-!2'07).<!&4(/)%02C!0.-!%&'!4*%;4,'!43!%&4('!'7'.%(k!f&0%!:'1'!%&'!;4,,4.!%&','(!)-'.%)3)'-!314,!%&')1!1'/41%'-!'L/'1)'.;'(k!

o! B4:!).7427'-!-)-!42-'1!/'4/2'!3''2!).!-';)()4.(!1'<01-).<!%&')1!-)(;&01<'!0.-!&4:!,*;&!;&4);'!:0(!070)20+2'!%4!%&',k!

o! B4:!-)-!*('1(!0.-!;01'1(!-'(;1)+'!(4;)02!:41@!)./*%k!f&0%!:'1'!%&')1!4/).)4.(!43!%&)(!).%'10;%)4.k!

o! B4:!301!:'1'!%&')1!/(8;&4\(4;)02!.''-(!,'%k!o! B4:!-)-!%&'!/'1(/';%)7'(!43!%&'('!%:4!<14*/(!-)33'1k

!! To examine how social work operates within the care management model in hospital in the context of the discharge of older patients:!

!

o! B4:!-4!(4;)02!:41@'1(!-'(;1)+'!%&')1!142'!:)%&).!%&)(!;4.%'L%k!f&0%!;4,,4.!%&','(!;0.!+'!)-'.%)3)'-k!!

o! B4:!;0.!;01'!,0.0<','.%!('17);'(!%4!42-'1!/0%)'.%(!0.-!%&')1!30,)2)'(!+'!),/147'-k!

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! WK

o! B4:!-4!(4;)02!:41@'1(!1'20%'!%4!4%&'1!/143'(()4.(!).!%&)(!,*2%)-)(;)/2).018!('%%).<C!:)%&!1'<01-!%4!%&'!-)(;&01<'!43!42-'1!/0%)'.%(k!!

!! To investigate the effects of the Delayed Discharges legislation upon service users, carers, the professionals and their work, in the study hospital between 2004-6!

!

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WQH! Social work and its theoretical base - summary

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!

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!

WQU! Social work, care management and the research study

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"! National social policy and practice contexts

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!

Table 2.1!Average weekly numbers of patients of all ages, whose discharge from acute hospital care delayed from 2003-2008!NDADIC!"FFZ;T!XGO!!

Dates Weekly average numbers of patients

delayed in hospital

"FF#JH! #CKHF

"FFHJU! "CKXF

"FFUJK! "CHWF

"FFKJX! "C#KF

"FFXJZ! "CWGF

!

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!

Table 2.2!Reasons for delayed transfers of care for all patients in acute hospital beds in England 2007-8.!NDADIC!"FFZ;T!ZFOr!!

Reason for delay %

$:0)%).<!;4,/2'%)4.!43!0(('((,'.%! "W!

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"QK! Performance and regulation

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"QZ! Diversity and inequality

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Phenomenology briefly outlined

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Researcher’s standpoint

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HQ#! Research design

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Qualitative approach – interviews!S14,!%&'!4*%('%!)%!:0(!;2'01C!0(!-'%0)2'-!).!HQ"QWC!%&0%!%&'!,4(%!0//14/1)0%'!

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Field notes

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The progress of the research study and the gathering of dataT!(0,/2).<C!

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4.4 Validity of the research

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4.5 Ethical issues

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94.J/&8();02!41!',4%)4.02!;4,341%!:0(!7)%0228!),/41%0.%!%44C!341!'L0,/2'!@.4:).<!

:&'.!/01%);)/0.%(!-)-!.4%!:)(&!%4!;4.%).*'!')%&'1!:)%&!%&'!).%'17)':!41!:)%&!0!

/01%);*201!%4/);!%&0%!:0(!*/('%%).<!341!%&',C!0.-!I!1'3'1!%4!%&'!20%%'1!314,!%),'!%4!%),'!

-*1).<!%&'!/1'('.%0%)4.!43!%&'!-0%0!!

!

! GH

UQ!Preservation of anonymity, and ensuring privacyQ!D01'!&0-!%4!+'!%0@'.!:)%&!

(%410<'!43!%0/'(!0.-!%10.(;1)/%(!0.-!%&0%!.0,'(!43!/01%);)/0.%(!01'!.4%!).!%&'!(0,'!

/20;'!0(!;4-'(Q!S4224:).<!%10.(;1)/%)4.C!%&'!%0/'(!:'1'!24;@'-!0:08!0%!0!('/010%'!

()%'C!0%!%&'!*.)7'1()%8Q!94!0;%*02!/'1(4.!41!/20;'!.0,'(!&07'!+''.!*('-!).!%&'!

%&'()(!41!0.8!4%&'1!/*+2);0%)4.!%4!074)-!0.8!)-'.%)3);0%)4.Q!

!

E.(*1).<!/1)70;8!-*1).<!).%'17)':).<!;0.!+'!-)33);*2%!).!&4(/)%02!41!;01'!&4,'!('%%).<Q!

R&'!3)1(%!('17);'!*('1!/01%);)/0.%!I!,'%!4.!%&'!:01-!-)-!.4%!3''2!2)@'!2'07).<!&)(!+'-!%4!

%02@!%4!,'!).!0!/1)70%'!144,Q!A),)20128!4.'!;01'!&4,'!1'()-'.%!).()(%'-!4.!(%08).<!).!

&'1!;&0)1!).!%&'!24*.<'!1)<&%!+8!(%033!@)%;&'.!-441!(4!%&'1'!:0(!.')%&'1!5*)'%!.41!

;4.3)-'.%)02)%8!341!%&'!).%'17)':Q!A%033!0(@'-!4.'!4%&'1!1'()-'.%!).!%&'!24*.<'!)3!(&'!

:0(!:)22).<!%4!,47'!341!0!:&)2'C!:&);&!(&'!:0(!0.-!%&'!%&)1-!/'1(4.!:0(!30(%!0(2''/!

341!%&'!:&42'!43!4*1!-)(;*(()4.!

!

KQ!Treating all participants with respect and dignityQ!

$%!%&'!3)1(%!,''%).<!I!02:08(!;&';@'-!:)%&!/01%);)/0.%(!:&);&!.0,'!%&'8!:)(&'-!,'!

%4!*('C!10%&'1!%&0.!0*%4,0%);0228!0--1'(().<!%&',!+8!%&')1!341'.0,'(Q!I.!D&0/%'1(!

KJG!I!43%'.!1'3'1!%4!()%*0%)4.(!:&'.!('.()%)7'!)((*'(!;0,'!%4!%&'!341'C!'Q<Q!1'<01-).<!

+'1'07','.%C!:&'.!)%!:0(!.4%!/4(()+2'!%4!/14+'!0+4*%!/01%);)/0.%(P!'L/'1)'.;'(C!0(!

%&')1!.''-(!:'1'!/010,4*.%Q!g*-<','.%(!%&'1'341'!&0-!%4!+'!,0-'!0+4*%!(%4//).<!

).%'17)':).<!41!%0@).<!4%&'1!0//14/1)0%'!0;%)4.!0.-!;4.%).*0228!1'J0(('(('-!:)%&!

'0;&!/01%);)/0.%(Q!

!

XQ!I.!;0('(!:&'1'!).341,0.%(!&07'!communication difficulties 41!E.<2)(&!)(!.4%!

%&'!3)1(%!20.<*0<'C!'.(*1).<!%&0%!%&')1!7)':(!;0.!+'!&'01-!'Q<Q!7)0!0.!).%'1/1'%'1Q!$!

3':!/01%);)/0.%(!:'1'!()<&%!41!&'01).<!),/0)1'-!+*%!.4%!%4!%&'!/4).%!43!1'5*)1).<!

0--)%)4.02!'5*)/,'.%Q!S41!022!43!%&',!E.<2)(&!:0(!%&')1!3)1(%!20.<*0<'Q!9'7'1%&'2'((C!

I!1'02)('-!%&0%!I!-)-!.4%!02:08(!'L/1'((!,8('23!;2'0128!%4!/01%);)/0.%(!:&4!-)-!.4%!

*.-'1(%0.-!:&0%!I!&0-!(0)-!0.-!I!%&'.!&0-!%4!1'/&10('!5*'(%)4.(!41!/4).%(Q!

!

ZQ!Reciprocity. $+47'!I!&07'!:1)%%'.!0+4*%!stepping out of the researcher roleC!

:&'.!/01%);)/0.%(!.''-'-!0-7);'!41!341!34224:!*/!%4!+'!;011)'-!4*%!'Q<Q!+8!;4.%0;%).<!

%&')1!(4;)02!:41@'1!41!;01'!&4,'!,0.0<'1!03%'1!%&'!).%'17)':Q!R&'('!()%*0%)4.(!&0-!

%4!+'!;011)'-!4*%!:)%&!('.()%)7)%8!0.-!)3!0!/01%);)/0.%!+';0,'!7'18!-)(%1'(('-!I!:4*2-!

&07'!(4*<&%!3*1%&'1!0-7);'!314,!0//14/1)0%'!5*01%'1(!'Q<Q!(4;)02!:41@'1C!30,)28C!`>!

:)%&!%&')1!;4.('.%Q!?';)/14;)%8!-4'(!.4%!V*(%!,'0.!;4,/2'%).<!%&'!%&'()(!%&0%!)(!%&'.!

&)--'.!0:08!).!0!*.)7'1()%8!2)+1018!+*%!%&).@).<!0+4*%!,41'!0;;'(()+2'!341,(!43!

! GU

-)((',).0%)4.!(*;&!0(!V4*1.02!/0/'1(!0.-!;4.3'1'.;'!0.-!*('1!<14*/!/1'('.%0%)4.(Q!

R&)(!/1).;)/2'!43!-)((',).0%).<!0.-!(&01).<!%&'!3).-).<(!43!%&'!1'('01;&!01'!%&'!7'18!

2'0(%!%&0%!;0.!+'!-4.'!%4!0;@.4:2'-<'!%&'!%),'!<)7'.!+8!/01%);)/0.%(!/01%);*20128!

:&'.!.4!3''(!01'!/0)-!341!%&)(Q!

!

$22!%&'!0+47'!&0-!%4!+'!0--1'(('-!+8!%&'!1'('01;&'1!&'1('23!:&4!0(!:'22!0(!+').<!

0:01'!43!%&'('!)((*'(!:0(!+4*.-!+8!%&'!;4-'(!43!'%&);(!<47'1.).<!6.)7'1()%8!0.-!

(4;)02!:41@!9BA!1'20%'-!1'('01;&Q!

!

4.6 Conclusion

$(!,*;&!0(!0.8%&).<!'2('!%&)(!;&0/%'1!&0(!+''.!0+4*%!0!>&=!(%*-'.%P(!c7480<'!43!

-)(;47'18PC!314,!2'01.).<!0+4*%!-)33'1'.%!/&)24(4/&);02!0//140;&'(C!,'%&4-424<)'(!

0.-!,'%&4-(!%4!:&0%!)%!)(!%4!+'!0!(4;)02!:41@!1'('01;&'1!10%&'1!%&0.!/10;%)%)4.'1Q!I!

5*);@28!1'02)('-!%&0%!,*;&!43!%&'!;4.-*;%!43!0!1'('01;&!/14V';%!)(!+'84.-!4.'P(!

;4.%142C!341!'L0,/2'!;&0.<'(!%4!24;02!0.-!;'.%102!<47'1.,'.%!/42);8!0.-!

41<0.)(0%)4.C!0.-!&07).<!%4!;4,/28!:)%&!/14;'-*1'(!('%!*/!0(!%&'8!:'1'!%&'.C!

/1).;)/0228!341!,'-);02!1'('01;&Q!R&'!.'L%!;&0/%'1!:)22!34;*(!4.!-'(;1)+).<!%&'!

('%%).<!341!%&'!(%*-8!24;02)%8!0.-!;4.%).*'!%&'!7480<'!+'<*.!0+47'T!%&'!/14;'((!0.-!

/14<1'((!43!-0%0!<'.'10%)4.!).!%&0%!24;02)%8Q!

!!

! GK

U! Study locality and data generation

UQW! Introduction

!

R&)(!;&0/%'1!:)22!-'(;1)+'!%&'!01'0!:&'1'!%&'!(%*-8!/01%);)/0.%(!2)7'-C!:)%&!(4,'!

-',4<10/&);!).341,0%)4.!0.-!+0();!&'02%&!).-);0%41(Q!I%!:)22!34;*(!*/4.!%&'!(4;)02!

('17);'(!-'/01%,'.%!0.-!%&'!(%*-8!&4(/)%02!:&'1'!%&'!(4;)02!:41@!%'0,!:0(!

&4*('-Q!R&'!;&0/%'1!:)22!+1)'328!(@'%;&!%&'!(%*-8!+0;@-14/!J!0!%4:.!%&0%!&0(!+'24:!

07'10<'!.*,+'1(!43!/'4/2'!314,!,).41)%8!'%&.);!<14*/(C!%&'!*.',/248'-!0.-!

1'/41%'-!/441!&'02%&!(*33'1'-!+8!)%(!1'()-'.%(Q!R&'!24;02!0*%&41)%8!;4,/20).(!

0..*0228!0+4*%!0.!).0-'5*0%'!).;4,'!('%%2','.%!314,!;'.%102!<47'1.,'.%!+*%!)%!&0(!

02(4!&)(%41);0228!(/'.%!2'((!/14/41%)4.0%'28!4.!42-'1!/'4/2'!%&0.!,4(%!4%&'1!;4*.;)2(!

43!(),)201!()l'!0.-!.0%*1'Q!R&'!-'(;1)/%)4.!:)22!02(4!+1)'328!244@!0%!/'1341,0.;'!43!

&'02%&!0.-!(4;)02!('17);'(!).!<47'1.,'.%02!%'1,(Q!!

!

R&'!).341,0%)4.!0+4*%!%&'!24;02)%8!:0(!-10:.!314,T!

!! A%0%)(%);(!070)20+2'!314,!%&'!`'.'102!B4*('&42-!A*17'8C!!

!! R&'!AAI!I.(/';%)4.!43!"FFW!0.-!,41'!1';'.%!24;02!0*%&41)%8!/14<1'((!1'/41%(!!

!! R&'!0;*%'!&4(/)%02!%1*(%P(!-0%0!314,!0..*02!1'/41%(!0.-!%&'!>0%)'.%(P!

EL/'1)'.;'!R'0,!

!! R&'!).-'/'.-'.%!B'02%&;01'!D4,,)(()4.P(!0(('((,'.%!43!%&'!&4(/)%02!

%1*(%Q!

!

R&'!;&0/%'1!%&'.!;4.()-'1(!%&'!/14;'((!43!-0%0!<'.'10%)4.C!(4,'!43!%&'!)((*'(!0.-!

;&022'.<'(!'.;4*.%'1'-!024.<!%&'!:08!0.-!%&'!0.028%);02!/0%&:08!34224:'-!).!41-'1!

%4!0--1'((!%&'!1'('01;&!5*'(%)4.(!:&);&C!).!+1)'3C!:0(!0;&)'7'-!+8T!

!

!! D4.-*;%).<!"G!).%'17)':(!43!0!(0,/2'!43!('17);'!*('1(!:&4!&0-!2'3%!&4(/)%02!

0.-!%&')1!;01'1(!:&'1'!0//14/1)0%'!0.-!/'1,)(()+2'!

!! S0;)2)%0%)4.!43!3)7'!34;*(!<14*/(!:)%&!@'8!/143'(()4.02(!).7427'-!).!&4(/)%02!

-)(;&01<'!

!! f''@28!7)()%(!%4!%&'!&4(/)%02!(4;)02!:41@!-'/01%,'.%!"FFHJK!

!! b''/).<!0!3)'2-:41@!-)018!

!

R&'!-'%0)2(!43!%&'!0+47'!;0.!+'!34*.-!0%!UQ#!+'24:Q!

!

! GX

R&)(!;&0/%'1!('%(!%&'!(;'.'!341!%&'!-0%0!;422';%)4.!;4,/4.'.%!43!%&'!1'('01;&!

/14V';%!0.-!0;%(!0(!0!+1)-<'!+'%:''.!+0;@<14*.-!).341,0%)4.!0.-!%&'!/1'('.%0%)4.!

43!%&'!3).-).<(Q!

!

[8!(%*-8!:0(!;4.-*;%'-!:)%&!42-'1!/0%)'.%(!0.-!%&')1!30,)2)'(!34224:).<!-)(;&01<'!

314,!0!201<'!0;*%'!-)(%1);%!&4(/)%02!).!0!,'-)*,!()l'-!.41%&'1.!E.<2)(&!%4:.C!0.-!

:)%&!,',+'1(!43!(%033!:41@).<!).!%&'!&4(/)%02Q!I.!41-'1!%4!,''%!1'5*)1','.%(!341!

0.4.8,)%8!43!/01%);)/0.%(C!.4!3*1%&'1!)-'.%)38).<!-'%0)2(!;0.!+'!<)7'.Q!

!

UQ"! The study locality

!

UQ"QW! R&'!('%%).<!341!%&'!1'('01;&C!314,!:&'1'!/01%);)/0.%(!41)<).0%'-!

A%01%).<!:)%&!(4,'!+0();!-',4<10/&);(C!%&'!%4:.P(!/4/*20%)4.!).!,)-!"FFH!:0(!

WZ#CFFFQ!$+4*%!%:4!%&)1-(!43!%&'!/4/*20%)4.!2)7'!).!%&'!*1+0.!;'.%1'!43!%&'!01'0C!%&'!

1'(%!).!(0%'22)%'!7)220<'(!41!).!%&'!1*102!/01%(!%&0%!01'!(*114*.-!%&'!%4:.!0.-!<4!

+'84.-!)%(!+4*.-018Q!Y.28!0+4*%!Ws!43!%&'!/4/*20%)4.!01'!314,!,).41)%8!'%&.);!

<14*/(!0.-!7'18!3':!43!%&4('!01'!;*11'.%28!'2-'1(Q!!R0+2'!UQW!(&4:(!+1'0@-4:.!43!

%&'!42-'1!/4/*20%)4.!).!%&'!24;02)%8!+8!0<'!10.<'C!0.-!0!/14V';%)4.!*/!%4!%&'!.'L%!

-';0-'T!

!

Table 5.1 Study locality populations by age and projection!

!

Age group 2001 % 2016 projection

%

tKU! WUFCHKH Z# WUHCFXZ! ZF!

KUJXH! WUCZFH G "WCFFF! WW!

XUJZH! WWCF#" K WWCXFF! K!

ZUx! #CXGH " UCWFF! #!

Total 181,094 100 191,878 100.00

!

Source: SSI Inspection of study locality Older People’s Social Services 2001

!

R&)(!)(!0.!*.1',01@0+2'!/20;'!).!%&0%!*.',/248,'.%!)(!:'22!+'24:!%&'!.0%)4.02!

07'10<'!0.-!-'/1)70%)4.!;4.3).'-!%4!7'18!3':!/4;@'%(!).!%&'!%4:.Q!f0<'(!&4:'7'1!

01'!<'.'10228!24:!:)%&!,0.8!V4+(!+').<!).!('17);'!).-*(%1)'(C!2)%%2'!,0.*30;%*1).<!

0;%)7)%8!1',0).(C!+*%!0(!).!,0.8!4%&'1!01'0(C!&4*('!/1);'(!&07'!;4.%).*'-!%4!

).;1'0('C!;'1%0).28!*/!%4!'0128!).!"FFZQ!f&)2'!%&'('!30;%41(!,08!.4%!033';%!42-'1!

/'4/2'!-)1';%28C!%&'8!;'1%0).28!),/0;%!*/4.!84*.<'1!30,)28!,',+'1(!0.-!%&'!

).;1'0('!43!/14/'1%8!702*'!&0(!;4.%1)+*%'-!%4!%&'!/0(%!(02'!43!,0.8!;01'!&4,'(Q!

! GZ

R&'!/&'.4,'.4.!43!42-'1!c'5*)%8!1);&C!;0(&!/441P!1'()-'.%(!2)7).<!).!43%'.!*.(*)%0+2'!

0.-!).0-'5*0%'28!,0).%0).'-!&4*().<!)(!02(4!'7)-'.%Q!

!

$+4*%!&023!43!%&'!42-'1!/4/*20%)4.!43!%&'!%4:.!2)7'!).!().<2'!/'1(4.!&4*('&42-(Q!R&'!

.*,+'1!43!1'()-'.%(!1';')7).<!&4,'!;01'!3'22!(2)<&%28!&4:'7'1!).!"FFHJU!%4!WCHHUQ!$(!

R0+2'!UQ"!(&4:(C!%&'!/'1;'.%0<'!43!/'4/2'!:)%&!0!24.<J%'1,!)22.'((!0.-!/441!<'.'102!

&'02%&!).!%&'!01'0!43!(%*-8!)(!+'24:!%&'!.0%)4.02!0.-!1'<)4.02!07'10<'C!0(!)(!%&'!

/'1;'.%0<'!43!%&4('!:&4!/147)-'!*./0)-!;01'!"FJUF!&4*1(!0!:''@Q!R&'!-0%0!('%!

+'24:!(&4:(!2'7'2!43!<'.'102!&'02%&!0.-!*./0)-!;01).<!).!%&'!%4:.C!0.-!1'<)4.!

;4,/01'-!:)%&!%&'!;4*.%18!0(!0!:&42'!-*1).<!%&'!/'1)4-!43!%&'!(%*-8QQ!!

!

Table 5.2: Health and provision of unpaid care in the study local authority, 2004-5

!

Local Authority Region England

$22!>'4/2'! 94Q! WZWFGH! HGKHZ##! HGW#ZZ#W!

>'4/2'!:)%&!0!2),)%).<!24.<J%'1,!)22.'((! 94Q! #FFKH! GKX"ZH! ZZFGWGH!

! s! WKQK! WGQHZ! WXQG#!

>'4/2'!43!:41@).<!0<'!:)%&!0!2),)%).<!24.<J%'1,!)22.'((! 94Q! W"UFK! HHFF#X! HFWHFFU!

! s! WFQGK! WHQUU! W#Q"G!

`'.'102!&'02%&T!!`44-! 94Q! W"X"H"! ##"HUU#! ##XZX#KW!

! s! XFQ"K! KKQGK! KZQXK!

`'.'102!&'02%&T!!S0)128!<44-! 94Q! #G#KU! WW"G"FK! WFGWUUGH!

! s! "WQXH! ""QXH! ""Q"W!

`'.'102!&'02%&T!!94%!<44-! 94Q! WHHZX! UWWFXH! HH#UZXK!

! s! Z! WFQ"G! GQF#!

$22!/'4/2'!:&4!/147)-'!*./0)-!;01'! 94Q! WXFFG! UWZ"WW! HZXXFKF!

$22!/'4/2'!:&4!/147)-'!*./0)-!;01'T!WJWG!&4*1(!0!:''@! 94Q! W"HXZ! #HUHGW! ##HXU#W!

! s! X#Q#K! KKQKX! KZQKH!

$22!/'4/2'!:&4!/147)-'!*./0)-!;01'T!"FJHG!&4*1(!0!:''@! 94Q! WU"F! UZZUK! U#FXGX!

! s! ZQGH! WWQ#K! WFQZZ!

$22!/'4/2'!:&4!/147)-'!*./0)-!;01'T!UF!41!,41'!&4*1(!0!:''@! 94Q! #FWW! WW#ZKH! GGZX#"!

! s! WXQX! "WQGX! "FQHZ!

!

Source: General Household Survey NbAFZO!2004-5!

!

! GG

UQ"Q"! A4;)02!('17);'(!

!

Performance and inspection

I.!%'1,(!43!'L/'.-)%*1'!%&'!"FFW!AAI!).(/';%)4.!1'/41%!4.!%&'!).(/';%)4.!43!(4;)02!

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/'1(4.!341!42-'1!/'4/2'P!0.-!:0(!%&'!%&)1-!24:'(%!(/'.-'1!341!1'()-'.%)02!0.-!

<'.'102!;01'!).!%&'!;4,/010%41!<14*/!43!WK!;4*.;)2(Q!$.';-4%0228!)%!:0(!02:08(!

;20),'-!%&0%!%&'!%4:.!&0-!).&'1)%'-!+4%&!0!320%!,0.0<','.%!(%1*;%*1'!0.-!0!

1'20%)7'28!24:!('17);'!/147)()4.!314,!)%(!/1'-';'((41!1'<),'!43!0!;4*.%8!;4*.;)2Q!S41!

'L0,/2'!*.2)@'!0!.')<&+4*1).<!;)%8!(4;)02!('17);'(!-'/01%,'.%!%&'1'!:0(T!

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%&'!c'2-'128!,'.%0228!).3)1,P!NE[IO!1'<)(%10%)4.!;0%'<418!!

!! $!2),)%'-!1'(/)%'!(;&','!341!42-'1!41!-)(0+2'-!/'4/2'!%4!1'()-'!%',/4101)28!

:)%&!0//147'-!;01'1(!0.-!.4!/147)()4.!341!%&'!20%%'1!%4!(%08!).!('17);'!*('1(!

&4,'(!%4!<)7'!(&41%!+1'0@(!341!).341,02!;01'1(!N0/01%!314,!0<'.;8!()%%'1(!

/0)-!341!/1)70%'28O!

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Structure and organisation of the hospital social work team

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UQ"Q#! R&'!(%*-8!&4(/)%02!

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Performance of the hospital trust

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!

Table 5.3: Numbers and types of complaints re Elderly Care received by the

study hospital’s Patient Experience Team 2004-6

!

Type of complaint 2004/5 2005/6

! ! !

D4.;'1.).<!-)(;&01<'! #! H!

D4,,*.);0%)4.\/147)()4.!43!).341,0%)4.! U! W!

D01'!0.-!%1'0%,'.%!43!/0%)'.%(! "W! WZ!

Y%&'1! #! H!

Total 32 27

Total no of inpatient/day-cases 74,391 77,959

!

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1'/41%'-!0(!0%%10;%).<!HFFQ!

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R&'!24;02!0*%&41)%8!)(!1'3'11'-!%4!4.;'!1'<01-).<!;&)2-1'.P(!('17);'(!0.-!/0'-)0%1);(Q!

I.!%&'!R1*(%P(!0..*02!1'/41%!:&)2'!742*.%018!41<0.)(0%)4.!/147)()4.!)(!+1)'328!4*%2).'-C!

%&'1'!)(!.4!,'.%)4.!43!(4;)02!('17);'(Q!R&'!20%%'1P(!-'/01%,'.%!)(!:'22!'(%0+2)(&'-!

:)%&).!%&'!&4(/)%02!0.-!).;2*-'(!0!;*(%4,'1!('17);'!1';'/%)4.!4/'.!%4!%&'!/*+2);!0(!

-'(;1)+'-!0+47'!0.-!(/';)02)(%!(4;)02!:41@'1(!(*;&!0(!341!%&'!1'.02!*.)%!0.-!BI_Q!

!

A4,'!/4).%(!43!).%'1'(%!314,!0!24;02!742*.%018!41<0.)(0%)4.!<)7).<!%&')1!/'1(/';%)7'!

4.!&4:!%&'!&4(/)%02!0.-!24;02!0*%&41)%8!('17'(!42-'1!/'4/2'!:)22!+'!1'3'11'-!%4!).!%&'!

%&'()(!0.-!;0.!+'!34*.-!).!$//'.-)L!"Q!!

!

UQ#! Data generation

R&'!()%'!341!%&'!1'('01;&!(%*-8!:0(!('2';%'-!+';0*('!43!/1)41!@.4:2'-<'!43!%&'!

0;*%'!&4(/)%02!0.-!'L)(%).<!;4.%0;%(!:)%&!%&'!24;02!0*%&41)%8!(4;)02!('17);'(Q!I%!:0(!

%&'1'341'!/4(()+2'!%4!<0).!0;;'((!%4!/143'(()4.02(!0.-!('17);'!*('1(!0(!/4%'.%)02!

/01%);)/0.%(!341!%&'!(%*-8!0(!-'%0)2'-!).!HQHQWQ!R&'!1'(%!43!%&)(!;&0/%'1!34224:(!4.!

314,!D&0/%'1!HP(!34*.-0%)4.!43!<*)-).<!/&)24(4/&8C!0//14/1)0%'!,'%&4-424<8!0.-!

,'%&4-(C!%4!'20+410%'!*/4.!%&'!1'(*2%).<!4*%;4,'(!43!%&'!0//140;&!%4!%&'!1'('01;&!

5*'(%)4.(Q!

!

S14,!%&'!(%*-8!&4(/)%02!0.-!24;02)%8!-'(;1)+'-!0+47'C!0!%4%02!43!KW!('17);'!*('1(!0.-!

;01'1(!:'1'!1'3'11'-!%4!,'!0(!/4%'.%)02!/01%);)/0.%(!+8!%&'!&4(/)%02!(4;)02!:41@!

%'0,Q!$(!)(!).-);0%'-!+8!%&'!R0+2'!UQH!+'24:C!%&'!24:'1!/4).%!43!%01<'%!341!).%'17)':!

.*,+'1(!NWUJ"FO!:0(!'L;''-'-!I.!41-'1!%4!0;;'((!%&)(!<14*/!43!42-'1!/0%)'.%(!:&4!

&0-!1';')7'-!0!(4;)02!:41@!0(('((,'.%C!).!0--)%)4.!%4!,''%).<!%&'!;1)%'1)0!4*%2).'-!

+'24:C!/*1/4()7'!(0,/2).<!:0(!0-4/%'-Q!R&)(!%&'41'%);02!(0,/2).<!0//140;&!)(!0!

1';4<.)('-!0.-!),/41%0.%!%442!).!5*02)%0%)7'!1'('01;&!41T!!

!c('2';%).<!information-rich ;0('(!341!(%*-8!).!-'/%&Q!I.341,0%)4.!1);&!;0('(!01'!%&4('!314,!:&);&!4.'!;0.!2'01.!0!<1'0%!-'02!0+4*%!)((*'(!43!;'.%102!),/41%0.;'!%4!%&'!/*1/4('!43!%&'!'.5*)18eP!N>0%%4.C!"FF"T!"#FOQ!

!

! WFU

Table 5.4 Outcomes and numbers of referrals to the research project

Referrals No.

A'17);'!*('1(!).%'17)':'-r! WG!

D24('!1'20%)7'(\;01'1(!).%'17)':'-! WK!

?'3*('-!41!:)%&-10:.!03%'1!).)%)02!;4.%0;%! W"!

I.0//14/1)0%'!1'3'1102(! K!

='0%&(!+'341'!;4.%0;%! U!

f0.%'-!%4!%02@!47'1!%'2'/&4.'!4.28! "!

6.0+2'!%4!;4.%0;%! W!

TOTAL 61

!

*5 service users were interviewed jointly with their corresponding 6 carers,

see p.108 for details.

!

UQ#QW! ?';1*)%,'.%!43!(0,/2'!

Recruitment of potential service user participants to the study

B4(/)%02!(4;)02!:41@'1(!0<1''-!%4!,0@'!0.!).)%)02!0//140;&!%4!).-)7)-*02(!4.!%&')1!

;0('240-C!:&4!:'1'!)-'.%)3)'-!0(!/4%'.%)02!/01%);)/0.%(Q!R&'8!:'1'!02(4!).!0.!

0-70.%0<'4*(!/4()%)4.!%4!@.4:!:&'%&'1!%&'1'!:0(!0.8!1'0(4.!N'Q<Q!1';'.%!

+'1'07','.%O!:&8!)%!:4*2-!+'!).0//14/1)0%'!%4!;4.%0;%!0!('17);'!*('1!341!%&)(!

/*1/4('Q!A0,/2).<!).;2*()4.!;1)%'1)0!:'1'!0(!34224:(C!%&0%!%&'!/'1(4.!:0(T!

!

!! $.!).J/0%)'.%!47'1!KU!8'01(!42-!

!! B0-!;4.%0;%!:)%&!&4(/)%02!(4;)02!:41@'1!41!;01'!,0.0<'1!

!! 94%!).!%&'!%'1,).02!/&0('!43!)22.'((!41!&07).<!;4,,*.);0%)4.!-)33);*2%)'(!41!0!

;4.-)%)4.!%&0%!:4*2-!/1'7'.%!/01%);)/0%)4.!).!0.!).%'17)':!41!%&'!0+)2)%8!%4!<)7'!

).341,'-!;4.('.%!%4!%0@'!/01%!).!%&'!(%*-8Q!

!

R&'!1'0(4.!341!0-4/%)4.!43!%&'('!/01%);*201!;1)%'1)0!)(!/14+0+28!('23J'7)-'.%Q!!R&'!3)1(%!

%:4!01'!%4!'.0+2'!%&'!0),(!43!%&'!(%*-8!%4!+'!0;&)'7'-Q!R&'!20(%!4.'!:0(!*('-!341!

'%&);02!0.-!/10;%);02!/*1/4('(!J!0.!('17);'!*('1!@.4:.!%4!+'!%'1,).0228!)22!:0(!

-'','-!%4!&07'!%&'!1)<&%!not!%4!+'!0//140;&'-!341!0!1'('01;&!(%*-8C!0.-!,08!:'22!

+'!%44!)22!%4!/01%);)/0%'Q!I%!:0(!02(4!;1*;)02!%&0%!022!/01%);)/0.%(!:'1'!742*.%''1(!0.-!

;4*2-!*.-'1(%0.-!:&0%!<)7).<!;4.('.%!,'0.%!).!0;;41-0.;'!:)%&!N%&'!341,'1O!

DY?EDC!*.)7'1()%8!0.-!(4;)02!:41@!1'('01;&!<47'1.0.;'Q!!

!

! WFK

Recruitment of carer participants groups A and B to the study

f)%&!%&'!0<1'','.%!43!).341,0.%(!%&')1!;24('!1'20%)7'!41!;01'1 )3!0//2);0+2'C!:'1'!

;4.%0;%'-!%4!0(@!)3!%&'8!:4*2-!2)@'!%4!%0@'!/01%!).!%&'!(%*-8Q!A4!341!%&'('!/4%'.%)02!

;01'1!/01%);)/0.%!%&'1'!:'1'!%&1''!).;2*()4.!;1)%'1)0T!

!

!! 90,'-!+8!0!('17);'!*('1!/01%);)/0.%!0(!%&')1!;01'1C!1'20%)7'!41!()<.)3);0.%!

4%&'1Q!!

!! A'17);'!*('1!<07'!/'1,)(()4.!341!1'('01;&'1!%4!;4.%0;%!%&)(!/'1(4.!0(!

).-);0%'-!4.!*('1!/01%);)/0.%P(!;4.('.%!341,Q!

!! R&'!;01'1!.4%!).!%&'!%'1,).02!/&0('!43!)22.'((!41!&07).<!;4,,*.);0%)4.!

-)33);*2%)'(!41!0!;4.-)%)4.!%&0%!:4*2-!/1'7'.%!/01%);)/0%)4.!).!0.!).%'17)':!41!

%&'!0+)2)%8!%4!<)7'!).341,'-!;4.('.%!%4!%0@'!/01%!).!%&'!(%*-8Q!

!

I3!%&'8!:'1'!0<1''0+2'!%&'!;01'1(!41!1'20%)7'(!:'1'!0//140;&'-!).!%&'!(0,'!:08!0(!

%&'!('17);'!*('1(C!:)%&!0!%'2'/&4.'!;022!34224:'-!+8!0.!).%14-*;%418!7)()%!0.-!%&'!

<)7).<!43!).341,0%)4.!(&''%(!0.-!;4.('.%!341,(Q!R&'('!/01%);*201!;01'1!/01%);)/0.%(!

341,'-!0!<14*/!I!;022'-!D01'1!`14*/!$Q!!

!

I.!41-'1!%4!:)-'.!%&'!(0,/2'!%4!<0).!).()<&%!).%4!%&'!'L/'1)'.;'(!43!30,)2)'(!43!%&4('!

42-'1!/'4/2'!:&4('!1'20%)7'!&0-!+''.!-)(;&01<'-!314,!&4(/)%02!+*%!%4!:&4,!I!-)-!

.4%!&07'!0;;'((!-*'!%4!;4<.)%)7'!),/0)1,'.%C!0.!0,'.-,'.%!%4!%&'!1';1*)%,'.%!/20.!

341!%&'!(%*-8!:0(!,0-'C!1'3'11'-!%4!+'24:!).!UQ#QXQ!

R&'!).;2*()4.!;1)%'1)0!341!%&'('!/4%'.%)02!/01%);)/0.%(!:'1'!%&'1'341'T!

!

!! D01'1(!41!1'20%)7'(!43!/0%)'.%!47'1!KU!-)(;&01<'-!314,!&4(/)%02!+*%!%&0%!

/0%)'.%!:0(!*.0+2'!%4!<)7'!).341,'-!;4.('.%!%4!/01%);)/0%'!).!%&'!(%*-8!

!! >0%)'.%!@.4:.!%4!&4(/)%02!(4;)02!:41@'1!

!! B4(/)%02!(4;)02!:41@'1!0<1''0+2'!%4!;4,/2'%'!0!0(('.%!341,!(%0%).<!%&0%!

/01%);)/0%)4.!:4*2-!.4%!&01,!%&'!/0%)'.%!

!! D01'1!41!1'20%)7'!.4%!).!%&'!%'1,).02!/&0('!43!)22.'((!41!&07).<!

;4,,*.);0%)4.!-)33);*2%)'(!41!0!;4.-)%)4.!%&0%!:4*2-!/1'7'.%!/01%);)/0%)4.!).!

0.!).%'17)':!41!%&'!0+)2)%8!%4!<)7'!).341,'-!;4.('.%!%4!%0@'!/01%!).!%&'!(%*-8Q!

!

B4(/)%02!(4;)02!:41@'1(!,0-'!%&'!).)%)02!;4.%0;%!:)%&!%&'!;01'1!41!1'20%)7'!0.-!:)%&!

%&4('!/'1(4.(!/'1,)(()4.C!;4,/2'%'-!0(('.%!341,(!0.-!/0(('-!.0,'(!%4!,'Q!

D01'1(!:'1'!%&'.!0//140;&'-!).!%&'!(0,'!:08!0(!%&'!1'20%)7'(!41!;01'1(!0+47'C!

! WFX

0(@'-!)3!%&'8!:0.%'-!%4!/01%);)/0%'!).!%&'!(%*-8C!<)7'.!).341,0%)4.!(&''%(!0.-!

;4.('.%!341,(!)3!%&'8!:'1'!:)22).<Q!R&4('!1';1*)%'-!:&4!3*23)22'-!%&'!0+47'!;1)%'1)0!

341,'-!0!(,022'1!<14*/!43!;01'1!/01%);)/0.%(!.0,'-!D01'1(!`14*/!^!%4!-)(%).<*)(&!

%&',!314,!`14*/!$C!:&4!:'1'!1';1*)%'-!7)0!('17);'!*('1!/01%);)/0.%(!0(!-'(;1)+'-!

0+47'Q!S*22!-4;*,'.%0%)4.C!:&);&!0;;4,/0.)'(!%&'!433);)02!1'5*'(%!%4!%&'!(4;)02!

:41@'1(C!).;2*-).<!).341,0%)4.!(&''%(!0.-!0(('.%!341,!01'!).!$//'.-)L!ZQ!!

!

Recruitment of staff involved in hospital discharge of older patients to study

I.!41-'1!%4!;4.7'.'!%&'!(%033!34;*(!<14*/(!I!).)%)0228!4+%0).'-!/'1,)(()4.!341!*('!43!

(%033!%),'!-*1).<!:41@).<!&4*1(!314,!%&'!('.)41!,0.0<'1!41!+*-<'%!&42-'1!:)%&).!%&'!

0;*%'!%1*(%Q!R&)(!:0(!4+%0).'-!30)128!5*);@28!0.-!&07).<!1';')7'-!'%&);02!0//14702!341!

).341,0%)4.!0.-!;4.('.%!(&''%(!0.-!%&'!).%'17)':!0<'.-0C!I!%&'.!0//140;&'-!%&'!

2).'!,0.0<'1(!0%!%&'!&4(/)%02C!41!%&'!('.)41!;4.(*2%0.%!0.-!(4;)02!:41@!,0.0<'1!341!

%&'!-4;%41(!0.-!(4;)02!:41@'1(!1'(/';%)7'28Q!]).'!,0.0<'1(!0(@'-!341!742*.%''1(!

314,!%&')1!(%033!%4!%0@'!/01%Q!I!('.%!+0;@<14*.-!).341,0%)4.!4.!%&'!(%*-8!).!0--)%)4.!%4!

%&'!0341','.%)4.'-!-4;*,'.%0%)4.!0.-!433'1'-!%4!,''%!(%033!).!0-70.;'!%4!0.(:'1!

0.8!5*'1)'(!0.-!%4!%02@!3*1%&'1!0+4*%!%&'!1'('01;&!/14V';%!0.-!%&'!34;*(!<14*/(Q!I.!

0;%*02!30;%!.4.'!43!%&'!,0.0<'1(!0<1''-!341!,'!%4!;4,'!0.-!,''%!(%033!/1)41!%4!%&'!

<14*/(!41!('','-!%4!&07'!0.8!5*'(%)4.(Q!

!

I.;2*()4.!;1)%'1)0!341!(%033!:'1'!%&0%!%&'8!&0-!742*.%''1'-!%4!/01%);)/0%'!0.-!%&0%!%&'8!

:'1'!/143'(()4.02(!:41@).<!).!%&'!(%*-8!&4(/)%02!:)%&!42-'1!/0%)'.%(!/1)41!%4!

-)(;&01<'C!:&'%&'1!%&0%!+'!).!,*2%)-)(;)/2).018!0(('((,'.%C!%&'10/'*%);!

).%'17'.%)4.(!41!-)(;&01<'!/20..).<!'%;Q!>'1(4..'2!:'1'!3*1%&'1!341,'128!0(@'-!341!

%&')1!/'1,)(()4.!341!34;*(!<14*/!-)(;*(()4.(!%4!+'!1';41-'-!/1)41!%4!('(()4.(Q!

!

UQ#Q"! D4.-*;%).<!%&'!).%'17)':(!0.-!34;*(!<14*/(!

Individual interviews with service users

$.!).%14-*;%418!-)(;*(()4.!:0(!&'2-!:)%&!'0;&!/4%'.%)02!/01%);)/0.%!:)%&!%&')1!

0<1'','.%C!0.-!)3!%&'8!:'1'!:)22).<!%4!&'01!,41'C!%&'!/14V';%!:0(!3*228!'L/20).'-!0.-!

%&'!).341,0%)4.!(&''%!2'3%!:)%&!%&',!341!-'2)+'10%)4.Q!I!%&'.!%'2'/&4.'-!4.'!41!%:4!

-08(!20%'1!%4!/147)-'!3*1%&'1!;201)3);0%)4.C!0.(:'1!0.8!5*'1)'(C!0.-!/147)-).<!%&'!

/01%);)/0.%!:0(!&0//8!0.-!0+2'!%4!<)7'!).341,'-!;4.('.%C!%&'!).%'17)':!:0(!

0110.<'-Q!I.%'17)':(!20(%'-!+'%:''.!"F!,).*%'(!0.-!ZF!,).*%'(!0//14L),0%'28C!:)%&!

%),'!(/'.%!+'341'&0.-!0.-!03%'1:01-(C!%4!1'(/4.-!%4!0.8!5*'(%)4.(!0.-!4.!).341,02!

;4.7'1(0%)4.!-'/'.-).<!4.!%&'!1'5*)1','.%(!43!%&'!).-)7)-*02Q!$22!:'1'!%0/'-!:)%&!

! WFZ

%&'!/'1,)(()4.!43!%&'!/01%);)/0.%(C!0/01%!314,!4.'!:&'.!%&'!1';41-'1!30)2'-C!0.-!%&'.!

20%'1!%10.(;1)+'-!7'1+0%),Q!

!

I.!/10;%);'!%&'!).%14-*;%418!7)()%!%4!'L/20).!0+4*%!%&'!1'('01;&!0.-!:&0%!I!:0(!0(@).<!

341C!43%'.!%44@!0(!24.<!41!24.<'1!%&0.!%&'!0;%*02!).%'17)':Q!A'17);'!*('1!/01%);)/0.%(!

(/4@'!0%!2'.<%&!0+4*%!%&')1!+0;@<14*.-(C!30,)28!1'20%)4.(&)/(!0.-!:)-'1!'7'.%(!

:&'.!:'!-)-!.4%!&07'!%4!(%01%!:)%&!341,!()<.).<!0.-!%&'!('%%).<!*/!43!%&'!%0/'!

'5*)/,'.%Q![4(%!('17);'!*('1(!:'1'!@''.!%4!%'22!,'!0+4*%!%&')1!'0128!2)7'(C!%&')1!

:41@!0.-!;&)2-1'.!:&);&!341!%&'!,0V41)%8!:'1'!43%'.!&01-!/'1)4-(!/&8();0228!0.-!

';4.4,);0228C!+*%!:'1'!&0//)'1!1'32';%)4.(!).!%&'!,0).!%&0.!%&'!,41'!1';'.%!/0(%!43!

)22!&'02%&Q!I%!:0(!02(4!0!<44-!.4.J;4.%147'1()02!(%01%!%4!341,).<!0.C!02+')%!+1)'3C!

1'20%)4.(&)/!:)%&!%&'('!('17);'!*('1(Q!S41!'L0,/2'!4.'!:4,0.!1';022'-!0(!0!;&)2-!

('').<!f412-!f01!W!/20.'(!328).<!0+47'!0.-!0.4%&'1!,0.!&0-!247'-!&)(!V4+!:41@).<!

341!%&' ?4802![0)2!4.!%&'!.)<&%!,0)2!%10).(!%&0%!*('-!%4!1*.Q!

!

D01'1(P!/01%);)/0.%(!%'.-'-!%4!&07'!2'((!%),'!070)20+2'!%&0.!%&'!*('1(C!0.-!:'1'!

/'1&0/(!(2)<&%28!,41'!:018Q!B023!43!%&'!;01'1(!&0-!1'%)1'-!41!:'1'!.4%!:41@).<!-*'!%4!

();@.'((!41!-)(0+)2)%8Q!R&'!1'(%!:'1'!,)-!;01''1!0.-\41!+1).<).<!*/!0!30,)28!43!%&')1!

4:.Q!I%!)(!02(4!).%'1'(%).<!%4!.4%'!%&0%!%:4!43!%&'!('17);'!*('1!/01%);)/0.%(!N6WU!

0.-WKO!:&4!&0-!+''.!).!&4(/)%02C!:'1'!02(4!;01'1(!43!%&')1!(/4*('(!0.-!0!%&)1-!

N6WWO!&0-!;01'-!341!&)(!:)3'!*.%)2!&'1!-'0%&Q!S)7'!('17);'!*('1(!:'1'!).%'17)':'-!

V4).%28!:)%&!%&')1!;01'1(!0%!%&')1!1'5*'(%C!0(!).-);0%'-!4.!%&'!R0+2'!+'24:T!6YWF!:)%&!

DYKM!6W"!:)%&!DYXM!6WH!:)%&!DYG!0.-!DYWFM!6WK!:)%&!DWKM!0.-!6WG!:)%&!DWUQ!

R&'!1',0).).<!('17);'!*('1(!0.-!;01'1(!:'1'!).%'17)':'-!).-)7)-*0228!0.-!

('/010%'28Q!$(!%&'!('17);'!*('1(!:'1'!).%'17)':'-!3)1(%!d!0/01%!314,!%&'!;01'1(!43!

/0%)'.%(!:)%&!;4<.)%)7'!),/0)1,'.%!).!`14*/!^C!%&'8!43%'.!/147)-'-!+1)'3!+0;@<14*.-!

).341,0%)4.!0+4*%!%&')1!;01'1(!0.-!4%&'1!30,)28!,',+'1(Q!?'3'1102(!43!/4%'.%)02!;01'1!

/01%);)/0.%(!%4!`14*/!^!:&4!:4*2-!+'!'2)<)+2'!*.-'1!%&'!'L%'.-'-!;1)%'1)0!;0,'!).!

(24:'1!%&0.!0.%);)/0%'-C!0.-!%&)(!1'(*2%'-!).!4.28!0!3*1%&'1!34*1!).%'17)':(!%0@).<!

/20;'Q!

!

Characteristics of sample interviewed

R0+2'!UQU!+'24:!(&4:(!%&'!,0).!;&010;%'1)(%);(!43!%&'!('17);'!*('1!(0,/2'Q!

!

!

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Table 5.6 Compositions of staff focus discussion groups

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Profession No. * Female Male

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1. Location of service user participants

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2. Follow up interviews

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4. Inclusion of carers of service users with cognitive impairment

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Transcription

E0;&!).%'17)':!0.-!34;*(!<14*/!-)(;*(()4.!:0(!%10.(;1)+'-!7'1+0%),!0(!(44.!0(!

/4(()+2'!03%'1!%&'8!:'1'!&'2-Q!Y.28!4.'!).%'17)':!:0(!.4%!%0/'!1';41-'-!-*'!%4!0!

%';&.);02!/14+2',Q!Y.'!).%'17)':!:)%&!0!1'20%)7'!:0(!43!/441!5*02)%8!-*'!%4!0.4%&'1!

-)33);*2%8!:)%&!%&'!'L%'1.02!,);14/&4.'Q!S41!%&'('!%:4!).%'17)':(!-'%0)2'-!.4%'(!:'1'!

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;4*/2'!43!),/41%0.%!3*22!5*4%'(Q!!

Interview summaries

S4224:).<!%10.(;1)/%)4.C!I!34*.-!)%!*('3*2!%4!:1)%'!4.'J/0<'!(*,,01)'(!N?)2'8C!WGGKO!

%&0%!&07'!&'2/'-!).!24;0%).<!;'1%0).!3'0%*1'(!314,!).-)7)-*02!%10.(;1)/%(Q!

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Checking back with participants

E7'18!/01%);)/0.%!:0(!0(@'-!)3!%&'8!:4*2-!2)@'!0!;4/8!43!%&'!%10.(;1)/%C!341!1'0(4.(!43!

;4*1%'(8!0.-!%4!;&';@!+0;@!:)%&!%&',!341!30;'!702)-)%8Q!R&4('!:&4!%44@!/01%!).!%&'!

%:4!24.<'1!).%'17)':(!-'(;1)+'-!0+47'C!0.-!4.'!4%&'1!;01'1!:'1'!%&'!4.28!/'4/2'!

:&4!:0.%'-!%4!244@!0%!%10.(;1)/%(C!:&);&!I!-*28!('.%Q!S41!%&'!341,'1!I!433'1'-!%4!;022!

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).%'17)':(C!I!:4*2-!(*,,01)('!0.-!,0@'!).%4!0!,41'!;4&'1'.%!0.-!1'0-0+2'!

0;;4*.%!43!%&'!:&42'!'/)(4-'!43!2'07).<!&4(/)%02!0.-!:&0%!&0-!2'-!*/!%4!)%!0.-!%&'!

4*%;4,'Q!R&'!4.'!('17);'!*('1!:&4!0<1''-!%4!(''!,'!('','-!7'18!&0//8!:)%&!%&'!

,0%'1)02!0.-!4.28!;4,,'.%'-!).!0!/4()%)7'!:08!%&0%!%&'1'!:'1'!%&).<(!(&'!&0-!

341<4%%'.Q!A&'!;4.3)1,'-!%&0%!%&'!;4.%'.%!:0(!0.!0;;*10%'!/41%10802!43!:&0%!&0-!

&0//'.'-!%4!&'1!0.-!4*1!-)(;*(()4.!%&0%!&0-!).;2*-'-!&'1!30,)28!:&4!+8!%&'.!&0-!

2'3%!%&'!01'0!%4!1'%*1.!%4!%&')1!4:.!0;;4,,4-0%)4.Q!

Thematic analysis!!

R&'!10%)4.02'!341!%&'!0//140;&!%4!%&'!0.028()(!43!%&'!-0%0!0.-!%&'!2).@!:)%&!%&'!(%*-8!

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+8!/1).%).<!4*%!('/010%'!;4/)'(!43!).%'17)':!%10.(;1)/%(C!'0;&!).!0!-)33'1'.%!34.%Q!

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/0%%'1.(C!1'20%)4.(&)/(!+'%:''.!-0%0!+)%(!0.-!1'J4;;*1'.;'(!).!1'20%)4.!%4!%&'!<*)-'!

0(!0!:08!43!<14*/).<!;4,,4.!-0%0Q!I!3*1%&'1!('01;&'-!%10.(;1)/%(!c,0.*0228P!341!

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(4,'!43!%&'!;01'1!/01%);)/0.%(Q!I!02(4!244@'-!341!(),)201!%&','(!%4!%&4('!%&0%!&0-!

+''.!34*.-!).!;4,/010+2'!1'('01;&!(%*-)'(Q!!

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341!'0('!43!7)(*02!;&';@).<!+0;@!0.-!341%&!341!;4,/01)(4.!-*1).<!0.028()(!0.-!

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%&',0%);!20+'2(!:&);&!,0-'!,4(%!('.('!).!%'1,(!43!1'(/4.-).<!%4!%&'!/14V';%!0),(!

43!('17);'!*('1(P!'L/'1)'.;'(!43!%&')1!-)(;&01<'C!%&'!4/'10%)4.!43!(4;)02!:41@!0.-!%&'!

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KF!;0%'<41)'(!0.-!()L!(*+J%&','(!;0.!+'!34*.-!).!$//'.-)L!WFQ!

Illustrative case examples

D&0/%'1!H!).;2*-'(!0!-)(;*(()4.!43!%&'!;0('!(%*-8!0//140;&C!,'%&4-(!0.-!10%)4.02'!

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;0('!'L0,/2'(!0.-!-0%0!/1'('.%0%)4.!;&0/%'1(!XJG!)(!0.4.8,)('-!%4!/14%';%!%&'!

)-'.%)%)'(!43!022!/01%);)/0.%(!0(!:0(!0<1''-!:)%&!%&',Q!

!

UQH! Conclusion

R&'!3)1(%!/01%!43!%&)(!;&0/%'1!(@'%;&'(!%&'!,);14J/42);8!+0;@<14*.-!341!&'02%&!0.-!

(4;)02!;01'!0%!%&'!%),'!3)'2-:41@!:0(!;4.-*;%'-!0.-!%&'.!34;*('(!4.!%&'!/14;'((!

0.-!/14<1'((!43!-0%0!<'.'10%)4.C!:&);&!%44@!/20;'!).!%&0%!24;02)%8Q!`)7'.!%&'!

&)(%41);0228!24:J(/'.-).<!+8!%&'!24;02!0*%&41)%8!4.!)%(!42-'1!/4/*20%)4.C!)%!)(!/'1&0/(!

.4%!(*1/1)().<!%&0%!:&)2'!%&'!;'.%10228!3*.-'-!(%*-8!&4(/)%02!&0(!/'1341,'-!:'22!

0;;41-).<!%4!<47'1.,'.%!,'0(*1'(C!0.-!&0(!0;&)'7'-!34*.-0%)4.!%1*(%!(%0%*(C!0-*2%!

(4;)02!;01'!341!42-'1!/'4/2'!&0(!+''.!2'((!3074*10+28!7)':'-!+8!).(/';%41(!:&4!

-14//'-!)%(!0(('((,'.%!43!/'1341,0.;'!).!"FFXJZ!%4!%&'!4.'!(%01!;0%'<418Q!B4(/)%02!

-)(;&01<'!:0(!'7'.!().<2'-!4*%!0(!0.!01'0!1'5*)1).<!(4,'!0%%'.%)4.!).!"FFWC!

).;2*-).<!).%'1J/143'(()4.02!1'20%)4.(&)/(!0.-!%&'!.*,+'1!43!(4!;022'-!-'208'-!

-)(;&01<'(!/1)41!%4!"FFHC!:&'.!%&'!2'<)(20%)4.!%4!;4,+0%!%&'!20%%'1!.0%)4.0228C!;0,'!

).%4!341;'Q!B4:'7'1!(4;)02!('17);'(!,0.0<','.%!:4*2-!;20),!%&0%!&01-!:41@!&0(!

+''.!-)1';%'-!0%!1'-*;).<!%&'!.*,+'1(!43!-'208'-!%10.(3'1(!43!;01'!0.-!%4!/1'/01'!

341!%&'!A).<2'!$(('((,'.%!>14;'((C!0,4.<(%!4%&'1!.0%)4.02!).)%)0%)7'(!,0.8!43!

:&);&!:'1'!-'%0)2'-!).!D&0/%'1!"Q!R&'!.'L%!34*1!;&0/%'1(!01'!;4.;'1.'-!:)%&!-0%0!

0.028()(!0.-!/1'('.%0%)4.Q!D422';%)7'28!%&'8!:)22!<)7'!0!(.0/(&4%!43!%&'!&*,0.!;4(%!

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30,)2)'(!0.-!%&'!(%033!).7427'-!).!&4(/)%02!-)(;&01<'Q!

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K! Case example

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KQW! Introduction

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'L0,/2'(!43!:&'1'!/0(%!0*%&41(!&07'!',/248'-!0!(),)201!(%10%'<8!:'1'!02(4!

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I.!<'.'102C!%&'!-0%0!34*.-!02(4!.''-!%4!+'!('%!).!%&'!;4.%'L%C!:&);&!<'.'10%'-!%&',C!

%&'!&)'101;&);02!(%1*;%*1'!43!0.!0;*%'!&4(/)%02!N[;]'4-!0.-!^8:0%'1(C!"FFFOQ!R&'('!

30;%41(!01'!/'1%).'.%!).!;4.()-'10%)4.!43!%&'!%&','(!%&0%!&07'!','1<'-!314,!%&'!

-0%0!/01%);*20128!%&4('!1'20%).<!%4!1'20%)4.(&)/(!:)%&!/143'(()4.02(Q!S*1%&'1!

).%'1/1'%0%)4.!43!&4:!%&'('!)((*'(!01'!-'02%!:)%&!).!%&'!2)%'10%*1'!0.-!),/2);0%)4.(!341!

3*%*1'!/10;%);'!01'!-)(;*(('-!).!D&0/%'1!WFC!34224:).<!%&'!20(%!43!%&'!%&','(!

;&0/%'1(Q!!

!

XQ"! Themes of loss and transition

!

XQ"QW! I.%14-*;%)4.!

R&'!1'(%!43!%&)(!;&0/%'1!(''@(!%4!+'<).!0--1'(().<!%&'!1'('01;&!0),(!).!WQ#!+8!

34;*().<!4.!%&'!'L/'1)'.;'(!43!;01'1(!0.-!%&'!('17);'!*('1(!:&4!:'1'!0-,)%%'-!0.-!

-)(;&01<'-!314,!%&'!(%*-8!&4(/)%02Q!I%!(%01%(!:)%&!-0%0!/1'('.%0%)4.!0.-!0.028()(!43!

/1'J0-,)(()4.!30;%41(!0.-!24((!43!341,'1!2)3'!0.-!).-'/'.-'.;'!0(!1'/41%'-!+8!

(4,'!43!%&'!('17);'!*('1!0.-!;01'1!/01%);)/0.%(Q!A';%)4.!XQ"!244@(!0%!24((!43!&4,'C!

%&'!,)L'-!3''2).<(!43!;01'1(!4.!;&0.<'C!('/010%)4.!43!/01%.'1(!0.-!+'1'07','.%Q!

B4(/)%02!0-,)(()4.!0.-!-)(;&01<'!).!%&'!(%*-8!;4.%'L%!01'!02(4!0+4*%!%&'!/&8();02!

%10.()%)4.!314,!&4,'!%4!).(%)%*%)4.C!0.-!314,!(%0<'(!43!0(('((,'.%!).!%&'!','1<'.;8!

-'/01%,'.%!%4!)./0%)'.%!%1'0%,'.%!0.-!3).0228!/1'/010%)4.!341!-)(;&01<'!41!

! W#H

1'&0+)2)%0%)4.Q!R&'('!;1)%);02!/4).%(C!0.-!&4:!('17);'!*('1(!0.-!%&')1!30,)2)'(!

0-V*(%'-C!1'J0-V*(%'-!0.-!;4/'-!:)%&!%&'!0;;4,/0.8).<!/(8;&4(4;)02!),/2);0%)4.(C!

:)22!+'!;47'1'-Q!R&'!;&0/%'1!%&'.!'.-(!4.!0!,41'!/4()%)7'!.4%'C!:)%&!0!3':!<0).(!

%&0%!('',!%4!&07'!+''.!'L/'1)'.;'-!+8!(4,'!42-'1!*('1(!-)(;&01<'-!314,!&4(/)%02Q

E2'7'.!43!%&'!('17);'!*('1!/01%);)/0.%(!(/4@'!%4!,'!).!0!(%1)@).<!:08!0+4*%!4.'!

0(/';%!41!,41'!43!%&'!24((!%&0%!%&'8!&0-!'.-*1'-Q!A)L!43!%&'!1',0).).<!')<&%!N34*1!

,02'(!0.-!%:4!3',02'(O!&0-!4+V';%)7'28!(*33'1'-!0!24((!%4!,8!@.4:2'-<'!+*%!-)-!.4%!

1'3'1!%4!)%C!0.-!%:4!('17);'!*('1(!2'3%!&4(/)%02!03%'1!(&41%!(%08(!:)%&!2'((!;4,/2'L!

.''-(!%&0.!%&'!,0V41)%8Q!90%)4.0228C!,41'!%&0.!&023!43!.':!0-,)(()4.(!%4!;01'!

&4,'(!:'1'!314,!&4(/)%02(!0.-!,4(%!43!%&'('!42-'1!/'4/2'!&07'!'.-*1'-!/'1(4.02!

24((!43!(4,'!@).-!NYSRC!"FFUT"OQ!I.!30;%!%&1''!43!%&'!WG!('17);'!*('1(!&0-!

'L/'1)'.;'-!%&'!1';'.%!-'0%&!43!0!(/4*('Q!!

!

XQ"Q"! >1'J0-,)(()4.!30;%41(!

R&'!'7'.%(!%&0%!/1';)/)%0%'-!%&'!0;%*02!&4(/)%02!0-,)(()4.C!:&);&!&07'!+''.!(''.!

0(!1'2'70.%!%4!%&'!-)(;&01<'!/14;'((!+8!(4,'!;4,,'.%0%41(!N'Q<Q!`4-31'8C!0.-!

[441'C!WGGKOC!01'!%&'!(%01%!43!%&'!V4*1.'8!0(!0!/0%)'.%!0.-!:'1'!0!*('3*2!/20;'!%4!

+'<).!'.<0<).<!).%'17)':''(!34224:).<!4*1!).%14-*;%418!;4.7'1(0%)4.(Q!6('1(!:'1'!

@''.!4.!%&'!:&42'!%4!-'(;1)+'!:&0%!&0//'.'-!%4!%&',!/1)41!%4!<4).<!).%4!&4(/)%02Q!

A*;&!;)1;*,(%0.;'(!201<'28!3'22!:)%&).!%&1''!,0).!<14*/).<(!).!%&'!-0%0T!!

!

WQ! A*--'.!4.('%!43!0!,0V41!)22.'((!41!%10*,0!341!%&4('!:&4!-'(;1)+'-!

%&',('27'(!0(!,0).28!0;%)7'!41!&'02%&8C!!

"Q! B)(%418!43!/441!&'02%&!;*2,).0%).<!).!0.!0;*%'!'/)(4-'!

#Q! $!<10-*02!-'%'1)410%)4.!43!)22!&'02%&C!43%'.!).7427).<!/1'7)4*(!0-,)(()4.(!%4!

&4(/)%02Q!!

!

R&'!;1*;)02!/4).%!341!%&'!(%*-8!:0(!%&0%!341!%&'!,0V41)%8!43!/01%);)/0.%(!%&')1!&4(/)%02!

0-,)(()4.!1'(*2%'-!).!-'%'1)410%)4.!).!%&'!2'7'2!43!).-'/'.-'.;'!341!%&',Q!!

!

I.!41-'1!%4!(&4:!&4:!0;%)7'!%&'!,0V41)%8!43!%&'!('17);'!*('1!/01%);)/0.%(!&0- +''.!

0.-!(4,'!:'1'!;4.%).*).<!%4!+'C!0%!%&'!/4).%!43!%&'!).%'17)':C!I!2)(%'-!(4,'!43!%&')1!

/'1(4.02!;4.%1)+*%)4.(!0(!-'(;1)+'-!%4!,'!).!R0+2'!XQW!+'24:T!

! W#U

Table 7.1 User participants’ reported interests prior to hospital admission and following discharge 2004-6

Participant Activity Continued post-discharge

6F"! A&4//).<C!;44@).<!0.-!;2'0.).<! 94!

6FH! D&*1;&!:41(&)/!0.-!742*.%018!:41@!

Y.28!0+2'!%4!0%%'.-!;&*1;&!0%!%),'!43!).%'17)':!

6FU! >208).<!:)%&!<10.-;&)2-1'.!0.-!-1)7).<!

94C!-';'0('-!

6FK! A&4//).<!0.-!;44@).<! w'(!

6FX! _42*.%''1!0%!0!;&01)%8!(&4/! 94!

6FG! ^022144,!-0.;).<! 94!

6WF! $-,).!:41@!0%!0!24;02!;&01)%8! 94!

6WW!! D01'1!341!(/4*('! 94!v!:)3'!-';'0('-!

6W#! >&4%4<10/&8!0.-!'2';%14.);(! A%)22!).%'1'(%'-!).!'2';%14.);(!

6WH! A';1'%018!43!0!.0%)4.02!;&01)%8! 94!

6WU!! D01'1!341!(/4*('! w'(C!:)%&!,41'!(*//41%!

6WK! D01'1!341!(/4*('! w'(C!:)%&!,41'!(*//41%!

6WX! A&4//).<!0.-!;44@).<! w'(!

6WG! `01-'.'1! w'(!:)%&!&'2/\0-0/%0%)4.(!

!

9Q^Q!I.341,0%)4.!.4%!070)20+2'!341!34*1!('17);'!*('1!/01%);)/0.%(!

!

!

Acute episodes of ill health!

R&1''!43!%&'!WG!&0-!310;%*1'-!+4.'(C!02%&4*<&!.4%!%&'!1'(*2%(!43!3022(!).!%&'!*(*02!

('.('!0(!34;*('-!4.!+8!%&'!=B!).!%&'!90%)4.02!A'17);'!S10,':41@!N=BC!"FFWOQ!S41!

%:4!('17);'!*('1!/01%);)/0.%(C!%&'!'/)(4-'!'7'.%*0228!1'(*2%'-!).!0!,47'!%4!0!;01'!

&4,'C!02%&4*<&!0!%&)1-!/01%);)/0.%!:&4!+14@'!&'1!01,!:0(!0+2'!%4!1'%*1.!&4,'!0!3':!

-08(!03%'1!(*1<'18Q!R&'!3)1(%!:0(!@.4;@'-!+0;@:01-(!+8!0!-4<!0.-!+14@'!&'1!&)/C!

0.-!%&'!(';4.-!0;;41-).<!%4!&'1!-0*<&%'1!?'.'!NDW"O!314,!D01'1(!`14*/!^T!mNA&'O!

<4%!*/!433!%&'!('%%''!0.-!+14@'!&'1!0.@2'C!(&'!-)-.P%!'7'.!3022!433!)%Q!A&'!V*(%!(%44-!

*/!0.-!%&0%P(!&4:!(&'!+14@'!)%C!(4!(),/2'ep!?'.'!:'.%!4.!%4!-'(;1)+'!&4:!&'1!

[4%&'1!%&'.!&0-!0!&'01%!0%%0;@!0.-!+14@'!&'1!&)/!).!&4(/)%02C!'7'.%*0228!+').<!

-)(;&01<'-!%4!0!-','.%)0!;01'!&4,'Q!B4:'7'1!I!was!0+2'!%4!%02@!%4!S24!N6F"O!%&'!

4%&'1!('17);'!*('1!/01%);)/0.%!:&4!&0-!3022'.!0.-!+14@'.!&'1!&)/C!:)%&!0!(),)201!

4*%;4,'!%4!?'.'P(![4%&'1Q!^'341'!&'1!&4(/)%02!0-,)(()4.!(&'!:0(!0;;*(%4,'-!%4!

0.!0;%)7'C!).-'/'.-'.%!2)3'!0(!(&'!).-);0%'-!).!%&'!34224:).<!'L%10;%T!

!

AST!!mA4!0%!&4,'C!+'341'!84*!:'.%!).%4!&4(/)%02C!-)-!84*!<4!4*%k!!U02T!!I!-)-!'7'18%&).<!341!,8('23M!I!-)-!4:.!,8!(&4//).<eI!/14+0+28!%42-!84*!%&0%!I!:0(!(%08).<!0%!,8!-0*<&%'1(!:&'.!I!3'22eQI%!0,0l'(!,'C!I!.'7'1!%&4*<&%!IP-!2)7'!%&)(!24.<!0.-!%&'.!022!43!0!(*--'.!'7'18%&).<!('','-!%4!<4!%4!

! W#K

/)';'(Q!I!:0(!7'18!)22!0.-!'.-'-!*/!).!&4(/)%02!J!%&'8!:'1'!V*(%!(08).<!%&0%!8'(%'1-08C!%&'8!:'1'!(%0.-).<!14*.-!,8!+'-!'L/';%).<!,'!<4).<Q!^*%!I!;0,'!%4<'%&'1!0<0).Qp

B'1'!0(!:)%&!(4,'!43!%&'!4%&'1!('17);'!*('1!/01%);)/0.%(!I!:0(!),/1'(('-!+8!:&0%!

('','-!0.!47'11)-).<!('.('!43!%&'!(&4;@!43!&07).<!3'2%!;24('!%4!24().<!4.'P(!2)3'Q!I%!

:4*2-!&07'!+''.!).%'1'(%).<!%4!@.4:!&4:!0.-!:&'%&'1!%&'!3''2).<(!1'<01-).<!%&'!

%10*,0!;&0.<'-!341!S24!47'1!%),'Q!A&'!-)-!1'3'1!%4!%&'!'/)(4-'!,41'!%&0.!4.;'!

-*1).<!%&'!).%'17)':C!+*%!%&'.!I!&0-!02(4!0(@'-!&'1!0+4*%!%&'!;)1;*,(%0.;'(!43!&'1!

0-,)(()4.!%4!&4(/)%02Q!

!

Gradual deterioration in health

9).'!('17);'!*('1(!-'(;1)+'-!0!,41'!<10-*02!-'%'1)410%)4.!:)%&!1'/'0%'-!(/'22(!).!

&4(/)%02Q!R&)(!,08!1'20%'!%4!%&'!3).-).<(!43!0!(8(%',0%);!1'7)':!NADIEC!"FFKOC!:&);&!

0(('1%'-!%&0%!42-'1!/'4/2'!;4*2-!7)':!&4(/)%02!0-,)(()4.!0.-!-)(;&01<'!0(!0!/01%!43!

2)3'P(!;4.%).**,!10%&'1!%&0.!;1)%);02!'7'.%Q!A%'/&'.!N6WZOC!341!'L0,/2'C!%42-!,'!43!

('7'102!/0(%!&4(/)%02!(%08(Q!B'!'L/20).'-!%&0%!&)(!&'02%&!/14+2',(!/14+0+28!

(%',,'-!314,!0!;01!0;;)-'.%C!:&);&!&0-!&0//'.'-!WK!8'01(!/1'7)4*(28Q!B'!:0(!

;*11'.%28!(*33'1).<!314,!*2;'10%'-!(@).!4.!&)(!+0;@!0.-!2'<(!%&0%!1'5*)1'-!%1'0%,'.%!

).!&4(/)%02!%&)(!%),'Q!

R:4!43!%&'!;01'1(!I!).%'17)':'-C!E20).'!NDWWO!0.-!g4'!NDWHOC!%02@'-!0+4*%!

:)%.'(().<!%&'!<10-*02!-'(;'.%!).%4!:41('.).<!-','.%)0!341!%&')1!/01'.%(!:&)2'!?48!

NDFUO!0.-!=41''.!NDFZO!(/4@'!43!<'.'102!-'%'1)410%)4.!).!%&'!/&8();02!&'02%&!43!

%&')1!$*.%(!N6FX!0.-!6FZOQ!]0%'1!).!%&'!;&0/%'1!I!-'(;1)+'!%&'!4*%;4,'!341!E20).'P(!

[4%&'1!:&4!.'7'1!0-V*(%'-!%4!;01'!&4,'!2)3'!0;;41-).<!%4!&'1!-0*<&%'1Q!$!3*22'1!

0;;4*.%!43!&'1!(%418!;0.!+'!34*.-!0(!0!;0('!'L0,/2'!).!$//'.-)L!"Q!

!

XQ"Q#! B4(/)%02!0.-!+'84.-!

R&'!+*2@!43!%&)(!;&0/%'1!34;*('(!4.!('17);'!*('1(!,47).<!4*%!43!&4(/)%02!).%4!0!;01'!

&4,'!41!1'%*1.).<!&4,'!:)%&!0!;01'!/0;@0<'Q!S41!,4(%!43!%&'!('17);'!*('1(!:&4!

,47'-!4*%!43!&4(/)%02!).%4!0!;01'!&4,'C!%&'!).%'17'.%)4.!43!1'20%)7'(!;4*2-!+'!

;1*;)02T!!

!

cR:4!'L0,/2'(!43!%&)(!i%10.()%)4.j!01'!%&'!/14;'((!43!-)(;&01<'!314,!&4(/)%02!0.-!0-,)(()4.!).%4!24.<J%'1,!;01'Q!^4%&!43!%&'('!'7'.%(!4;;*1!:&'.!/'4/2'!01'!0%!%&')1!,4(%!7*2.'10+2'C!3''2).<!/4:'12'((!%4!033';%!%&')1!2)7'(!).!0!/4()%)7'!:08C!0.-!43%'.!(*+V';%'-!%4!:'22J,'0.).<!+*%!-'(%1*;%)7'!<*)-0.;'!314,!30,)28!,',+'1(QP!N]8,+'18C!"FFUT!#WO!!

! W#X

!

R&'!1',0).).<!('17);'!*('1(!:&4!:'.%!+0;@!&4,'!&0-!%4!;4/'!:)%&!;&0.<'!:&'%&'1!

)%!:0(!%4!%&'!;4.('5*'.;'(!43!).;1'0('-!/&8();02!.''-(!0.-\41!%&'!/147)()4.!43!

&4,'!;01'!('17);'(Q!I!-)-!.4%!0;%*0228!0(@!('17);'!*('1(!&4:!%&'8!3'2%!0+4*%!coming

into!0(!4//4('-!%4!+').<!).!&4(/)%02!0.-!.4!4.'!742*.%''1'-!0.8!).341,0%)4.!4.!%&)(!

0(/';%Q!R&'!V4).%!9AS!1'7)':!NDADIC!DB$IC!9$YC!"FFKO!:0(!;1)%);02!43!,*2%)/2'!

,47'(!:)%&).!&4(/)%02!341!42-'1!/0%)'.%(Q!R&)(!:0(!10)('-!0(!0.!)((*'!+8!4.'!43!%&'!

;01'1(!).!%&'!`14*/!^Q!?'.'!NDW"O!341!'L0,/2'!%02@'-!0+4*%!%&'!'33';%(!43!%&'!

,47'(!341!&'1![4%&'1!:&4!(&'!+'2)'7'-!:0(!-'%'1)410%).<!,'.%0228!0(!:'22!0(!

/&8();0228!4.;'!(&'!:0(!).!&4(/)%02T!m^*%!)%!:0(!(*1/1)().<!(&'!,47'-!314,!:01-!%4!

:01-!%&'8!:'1'.P%!<'%%).<!%&'!3*22!,'-);02!-'%0)2(!/14/'128Qp NDW"OQ!R&'('!,'-);02!

-'%0)2(!).;2*-'-!<)7).<!?'.'P(![4%&'1!%&'!;411';%!-1*<(!0(!(&'!,47'-!:01-(Q

9'7'1%&'2'((![4.0!N6F#O!0.-!A%'/&'.!N6WZO!:&4!02(4!,47'-!014*.-!:)%&).!%&'!

&4(/)%02!:'1'!3*2(4,'!).!%&')1!/10)('!43!022!:01-(!0.-!022!(%033!'.;4*.%'1'-Q!B4:'7'1!

:'!(%01%!+8!244@).<!0%!&4:!-)(;&01<'!:0(!'L/'1)'.;'-!+8!('17);'!*('1(Q!R&'!(%0<'!

).J+'%:''.C!%&0%!)(!<0).).<!).341,0%)4.!4.!0.-!;4.()-'10%)4.!43!/4(%J-)(;&01<'!

02%'1.0%)7'(!0.-!%&'!-';)()4.!,0@).<!/14;'((!01'!244@'-!0%!('/010%'28!).!%&'!.'L%!

;&0/%'1Q!

!

Swift discharges from hospital

Y.;'!).!&4(/)%02!('17);'!*('1(!0.-!%&')1!30,)2)'(!:'1'!'L/';%'-!%4!5*);@28!'.<0<'!).!

/20..).<!341!%&'!3*%*1'Q!R0+2'!UQU!).!D&0/%'1!U!2)(%(!%&'!0;%*02!-'(%).0%)4.!0.-!4%&'1!

;&010;%'1)(%);(!43!('17);'!*('1(Q!Y3!%&4('!:&4!:'.%!%4!;01'!&4,'(!314,!&4(/)%02C!

).;2*-).<!%&'!('17);'!*('1(!1'3'11'-!%4!+8!;01'1(!).!`14*/!^!N.u"OC!()L!:'.%!%4!%&'!

(0,'!%10.()%)4.02!;01'!*.)%!).!0!.*1().<!&4,'C!:&'1'!B0118!N6WFO!02(4!,47'-!

/'1,0.'.%28Q!R:4!4%&'1!('17);'!*('1(!E1);!N6FUO!0.-![4.0!N6F#O!:'.%!%4!

/'1,0.'.%!/20;'(!).!-)33'1'.%!.*1().<!&4,'(Q!Y3!%&'!('7'.!('17);'!*('1(!:&4!:'.%!

).%4!1'()-'.%)02!;01'!%&'8!:'1'!022!0%!-)33'1'.%!24;0%)4.(C!+*%!%:4!*('1(!S24!N6F"O!0.-!

b')%&!N6WUO!:'1'!<)7'.!c%10.()%)4.02P!/20;'(!0.-!,08!'7'.%*0228!&07'!,47'-!0<0).Q!

R&'!1',0).).<!()L!42-'1!('17);'!*('1(!1'%*1.'-!&4,'Q!Y.'!/'1(4.C!D011)'!N6FKOC!

:0(!1'24;0%'-!%4!(*//41%'-!&4*().<Q!

!

A'7'.!43!%&'!('17);'!*('1(!1'3'11'-!%4!20;@!43!.4%);'!43!-)(;&01<'C!41!3''2).<!1*(&'-!

41!0!20;@!43!;&4);'!0+4*%!-)(;&01<'!-0%'Q!S41!%&4('!0:0)%).<!0!70;0.;8!).!0!;01'!

&4,'C!(*;&!0(!E1);!N6FUO!0.-!A)-!N6W"OC!4.;'!0!/20;'!)(!070)20+2'!)%!)(!

*.-'1(%0.-0+2'!%&0%!%&'!&4(/)%02!:0.%(!0!(/''-8!-)(;&01<'M!+*%!%&)(!;0.!;1'0%'!

-)33);*2%)'(!341!30,)2)'(!:&4!:0.%!%4!+'!(*//41%)7'C!(*;&!0(!^01+010P(!NDF#OC!A)-P(!

! W#Z

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N/WWHFOC!/'1&0/(!+';0*('!43!3'01!43!.4%!+').<!0+2'!%4!,''%!.''-(C!0.-!;4*.;)2(P!

/'1341,0.;'!+').<!0(('(('-!4.!(/''-!43!1'(/4.('!%),'(!0.-!0(('((,'.%(!:'1'!

-)(;*(('-!0(!1'2'70.%!)((*'(!&'1'Q!R&'!/0/'1!;4.;2*-'(!:)%&!&)<&2)<&%).<!0!;4,/2'L!

2'7'2!43!:41@!:)%&!42-'1!/'4/2'!30;).<!43%'.!)22!'5*)//'-!(4;)02!:41@!%'0,(!N/WWHKOQ!

I.!0.!4/'.).<!(*,,018!&4:'7'1!%&'1'!)(!0!;4.(%1*;%)7'!/&10().<!43!:&0%!)%!)(!%&0%!

42-'1!/'4/2'!-'()1'!0.-!.''-!314,!(4;)02!:41@'1(C!:&);&!)(!/01%);*20128!1'2'70.%!%4!

%&'!.'L%!(';%)4.!43!%&)(!;&0/%'1T!

!

cI%!:)22!(*<<'(%!%&0%!(4,'!43!%&'!31*(%10%)4.(!'L/1'(('-!+8!(4;)02!:41@'1(!

0+4*%!%&'!%'.()4.(!+'%:''.!,0.0<'1)02)(%!0<'.-0(!0.-!%&'!702*'(!43!%&')1!

/143'(()4.!01'!1'32';%'-!).!%&'!'L/'1)'.;'(!43!('17);'!*('1(Q!I.!0--)%)4.!)%!

(&4:(!%&0%!42-'1!/'4/2'!702*'!'.;4*.%'1(!%&0%!<4!+'84.-!%&'!(),/2'!

/147)()4.!43!).341,0%)4.!+*%!01'!144%'-!).!',/0%&);!0.-!@.4:2'-<'0+2'!

'.<0<','.%!:)%&!%&'!;4.;'1.(!43!).-)7)-*02!42-'1!/'4/2'!0.-!%&')1!;01'1(QP!

N[0.%&41/'!'%!02C!"FFZT!WW#HO!

!

B07).<!;4.()-'1'-!(%0@'&42-'1(P!/'1(/';%)7'(C!I!.4:!%*1.!%4!),/2);0%)4.(!341!%&'!

/10;%);'!43!&4(/)%02!(4;)02!:41@Q!

!

WFQK! Tensions in performing hospital social work

I!:4*2-!01<*'!%&0%!&4(/)%02!(4;)02!:41@!)(!(*+V';%!.4%!4.28!%4!%&'!%'.()4.(!%&0%!+'('%!

%&'!:&42'!/143'(()4.C!,0118).<!%&'!c(%10)%!V0;@'%P!43!341,02!0(('((,'.%!/14;'-*1'(!

0.-!2),)%'-!1'(4*1;'(!:)%&!).-)7)-*02!.''-!341!'L0,/2'C!+*%!02(4!%4!0--)%)4.02!

%'.()4.(!%&0%!01'!*.)5*'!%4!%&'!('%%).<Q!A),)201!%'.()4.(!).!%&'!&4(/)%02!(4;)02!

:41@'1P(!-0)28!14*.-!&07'!02(4!+''.!-'(;1)+'-!0(!balancing!.''-(!N^10-2'8!0.-!

[0.%&41/'C!"FFFOQ!b01'.!>4(%2'!).!&'1!/0/'1!'L/1'(('-!%&'!;4.;'/%!43!;01'!

,0.0<'1(!30;).<!+4%&!c0,+)<*)%)'(!0.-!%'.()4.(P!N"FF"T##UOC!(*,,01)('-!).!%&'!+4L!

+'24:!S)<*1'!WFQWQ!!

! "#W

!

Postle’s five tensions/ambiguities for social work !WQc?'(%1);%'-!1'(4*1;'(!%4!,''%!.''-(T!',/&0()(!4.!0(('((,'.%!43!.''-(P!"QcS4;*().<!4.!%&'!,).*%)0'!43!3).0.;)02!0(('((,'.%(T!-'02).<!:)%&!%&'!/'1(4.P!#QcA/'.-).<!%),'!4.!/0/'1:41@!0.-!IRT!%0@).<!%),'!%4!-'7'24/!0!1'20%)4.(&)/P!HQcI.;1'0().<28!;4,/2'L!:41@T!,41'!1'-*;%)4.)(%!/14;'(('(!(*;&!0(!;&';@2)(%(P!UQcD4.;'1.!0+4*%!022!0(/';%(!43!1)(@T!(/''-!43!:41@!%&14*<&/*%!).;1'0().<!1)(@QP!

!N>4(%2'C!"FF"T!#HFJ#HHO!

Figure 10.1 Postle’s tensions in social work practice

I.!).%'1/1'%).<!%&'!3).-).<(!43!&'1!4:.!(%*-8!4.!%&'!'L/'1)'.;'(!43!;01'!,0.0<'1(!).!

%:4!;4,,*.)%8!%'0,(!>4(%2'!1'3'1(!+0;@!%4!9IAf!1'('01;&!4.!%&'!(4;)02!;01'!

:41@341;'!N^0224;&C!>0&2!0.-![;]'0.C!WGGZOQ!R&'!0*%&41(!43!%&'!20%%'1!:14%'!

(),)20128!43!c;4.32);%).<!-',0.-(P!0.-!43!c142'!0,+)<*)%8P!02%&4*<&!(4,'!8'01(!20%'1!

:)%&!0!-)33'1'.%!0-,).)(%10%)4.!).!<47'1.,'.%C!I!:4*2-!01<*'!%&0%!c*.;'1%0).%8!0+4*%!

%&'!(;4/'!43!%&'!V4+P!N/XO!&0(!/14+0+28!1'-*;'-!:)%&!1'<01-!%4!;*11'.%!;01'!

,0.0<','.%!/10;%);'!:)%&!0-*2%(Q!R&'!S0)1!$;;'((!%4!D01'!<*)-0.;'!N=BC!"FF"+O!

;4*/2'-!:)%&!%&'!A).<2'!$(('((,'.%!>14;'((!&0(!-10(%);0228!;*1%0)2'-!(*;&!c(;4/'P!

2'%!024.'!;1'0%)7)%8!341!,8!(%*-8P(!(4;)02!:41@!%'0,Q!S*1%&'1,41'!4%&'1!/143'(()4.02(!

0.-!%&'!/*+2);!).!/01%);*201C!*.0:01'!43!(*;&!/42);8!0.-!/14;'-*102!;4.(%10).%(C!,08!

(%)22!1'0(4.0+28!1'5*'(%!('17);'(!314,!%&'!(4;)02!:41@'1C!:&);&!;0..4%!+'!(*//2)'-Q!

R'.()4.(!W!0.-!"!).!R0+2'!WFQW!+'24:!0//'1%0).!%4!&4(/)%02!-)(;&01<'C!+*%!>4(%2'P(!

c%'.()4.(!"!0.-!#P!NS)<!WFQWQO!01'!02(4!0+4*%!(/'.-).<!,41'!%),'!4.!0-,).)(%10%)4.!

0.-!/0/'1:41@!%&0.!4.!30;'J%4J30;'!;4.%0;%!0.-!1'20%)4.(&)/!341,0%)4.Q!B'1!c%'.()4.!

HPC!:&);&!)(!0+4*%!,0.0<).<!;4,/2'L!:41@!c:)%&!).;1'0().<28!1'-*;%)4.)(%!%442(!0.-!

/14;'(('(PC!)(!0.!).%'1'(%).<!%&','!%&0%!I!&0-!.4%!34*.-!).!,8!-0%0Q!I%!;4*2-!:'22!

0//28!%4!/'1341,0.;'!43!%0(@(!+8!&4(/)%02!(4;)02!:41@'1(!+*%!*.2)@'!%&')1!

;4*.%'1/01%(!).!>4(%2'P(!01'0!%'0,(C!%&'!341,'1!&0-!%4!*.-'1%0@'!022!).)%)02!

0(('((,'.%(!:&'%&'1!41!.4%!,41'!;4,/2'L!;01'!,0.0<','.%!:0(!2)@'28!%4!+'!%&'!

4*%;4,'Q!B4:'7'1!&'1!cU%&!%'.()4.P!1'<01-).<!&0.-2).<!43!1)(@!('',(!%4!34;*(!4.!%&'!

%'.()4.!;1'0%'-!341!(4;)02!:41@'1(!0.-!*('1(!J!:&4('!('23!-'%'1,).0%)4.!,)<&%!+'!0%!

(%0@'!J!+*%!)(!0<0).!0+4*%!&4:!+'(%!%4!;4/'!:)%&!*('1(!0%!1)(@!:)%&!).;1'0('-!

%&14*<&/*%!43!;0('(!341!&'1!%'0,(Q!R&'1'!:0(!(%14.<!3''2).<!0,4.<(%!%&'!&4(/)%02!

(4;)02!:41@!%'0,!).!,8!(%*-8!%&0%!1)(@!,0.0<','.%!;4*2-!0-7'1('28!033';%!*('1!

;&4);'Q!R&'8!<07'!'L0,/2'(!43!&'02%&!(%033!+').<!;4.;'1.'-!341!).-)7)-*02!1)(@!%4!%&'!

! "#"

'L%'.%!%&0%!/20.(!341!c(03'P!-)(;&01<'(!:'1'!(4,'%),'(!,0-'!:)%&4*%!;4.(*2%).<!%&'!

/0%)'.%C!0.-!).!%&)(!%&'1'!,08!&07'!+''.!-)(0<1'','.%!:)%&!1'20%)7'(!:&4!%'.-!%4!+'!

,41'!;0*%)4*(!%&0.!%&'8!:'1'!).!3074*1!43!).;1'0().<!).-'/'.-'.;'!341!%&'!*('1!

N]8,+'18C!"FFKOQ!!

!

Development of a model for hospital social work

R&'!,4-'2!4*%2).'-!+'24:!+*)2-(!*/4.!0.-!'L%'.-(!>4(%2'P(!:41@Q!I%!(&4:(!%'.()4.(!

43!/01%);*201!1'2'70.;'!%4!,*2%)-)(;)/2).018!/10;%);'!(*;&!0(!%&'!.''-!41!1'5*)1','.%!

341!(4;)02!:41@'1(!%4!)-'.%)38!:)%&!0(('((,'.%(!0.-!-)(;&01<'!/20..).<!%&0%!

',/&0()('(!('17);'!*('1(P!problemsC!10%&'1!%&0.!).!%&'!/14,4%)4.!43!%&'!(4;)02!

,4-'2!43!;01'Q!I!:4*2-!3*1%&'1!(*<<'(%!%&0%!%&'1'!01'!%'.()4.(!%&0%!;0.!+'!7)':'-!0(!

)((*'(!%&0%!01'!(&01'-!:)%&!*('1(!0.-!;01'1(C!0(!).!R0+2'!WFQW!(&4:).<!%'.()4.(!0.-!

%&'!34;*(!43!%&'!@'8!/208'1(!).%'10;%).<!:)%&!&4(/)%02!(4;)02!:41@'1(Q!

!

Table 10.1 Tensions in hospital social work, showing origins or focus!

NHS/LA Focus User/Carer Focus Social Work Focus

NWO!B4(/)%02!(8(%',J!-)(;&01<'!/14;'-*1'(!'%;!

I.-)7)-*02!.''-!!D01'1!.''-!!!!6('1\;01'1!'L/';%0%)4.!!

A4;)02!:41@!(*//41%!43!*('1(!0.-!;01'1(!!D01'!,0.0<','.%!!!>143'(()4.02!'L/';%0%)4.(!

N"OR*1.47'1! S41,).<!1'20%)4.(&)/(! S41,).<!1'20%)4.(&)/(!

N#O[*2%)-)(;)/2).018!%'0,!i[=Rj!

?';47'18\1'&0+)2)%0%)4.! >14,4%).<!(4;)02!,4-'2!!NHO!0-74;0;8!

NUOI.341,0%)4.!341!=B!'%;!

I.341,0%)4.!4.!('17);'(! I.341,0%)4.!341!0(('((,'.%!

A4;)02!/42);)'(!! 6('1\;01'1!).7427','.%! ]0;@!43!%),'!

$-,).)(%10%)4.! S0;'!%4!30;'!;4.%0;%! S0;'!%4!30;'!;4.%0;%(!!!

?'(4*1;'!070)20+)2)%8! 6('1!;&4);'! ?'(4*1;'(!%4!,''%!.''-!

?)(@!,).),)(0%)4.! 6('1!('23!-'%'1,).0%)4.! ?)(@!,0.0<','.%!

>'1341,0.;'!,0.0<','.%!

6('1\;01'1!41<0.)(0%)4.(! D&022'.<).<!%&'!(8(%',!

R&'!,0).!%'.()4.(!1'20%).<!%4!R0+2'!WFQW!0+47'C!/01%);*20128!1'2'70.%!%4!,4-'1.!-08!

&4(/)%02!(4;)02!:41@!0.-!34*.-!).!%&'!-0%0!;0.!+'!<14*/'-!).%4!3)7'!+140-!01'0(T!!

!

Tension 1: The demands of the hospital system versus individual need!

$!*('1!0.-!%:4!;01'1!/01%);)/0.%(!N6FHC!DF#!0.-!DWWO!'L/20).'-!&4:!%&'8!3'2%!-'J

/'1(4.02)('-!41!cV*(%!0!.*,+'1P!:)%&).!%&'!&4(/)%02Q!R:4!4%&'1(C!B0118!0.-!]8-)0!

N6WF!0.-!DKOC!(/4@'!0+4*%!%&'!1'5*)1','.%(!43!%&'!-)(;&01<'!/14;'((!41!%&'!

! "##

c&4(/)%02!(8(%',P!).!1'20%)4.!%4!&07).<!%4!2'07'!0.-!3).-).<!0!;01'!&4,'!/20;'!5*);@28!

341!B0118!0.-!(),)201!-)(%1'((!3'2%!+8!0.4%&'1!/0%)'.%!4.!%&'!:01-Q!$.!YR!1'3'11'-!%4!

0!20;@!43!0%%'.%)4.!%4!).-)7)-*02!.''-(!1'<01-).<!1'0-).'((!341!-)(;&01<'!0.-!%&'!

-)(1'<01-!341!%&4('!:&4!34*.-!,47).<!4.!-)33);*2%Q!A4;)02!:41@'1(!%02@'-!0+4*%!%&'!

(/';)3);!-'%1),'.%02!'33';%!43!-'208'-!-)(;&01<'!2'<)(20%)4.!*/4.!%&')1!:41@!:)%&!

*('1(!).!-)33'1'.%!()%*0%)4.(Q!I%!('','-!%4!+'!0!(%1*<<2'!341!%&',!%4!4+%0).!'7'.!0!3':!

&4*1(!24.<'1!341!/0%)'.%(!%4!1',0).!4.!%&'!:01-(!341!(/';)3);!1'0(4.(Q!R&'1'!:0(!

02(4!0.!'L0,/2'!43!%&)(!I!34*.-!).!,8!3)'2-!.4%'(!43!0!(4;)02!:41@'1!:&4!%1)'-!%4!

/'1(*0-'!0!:01-!%4!1'%0).!0.!42-'1!/0%)'.%!).!&4(/)%02!24.<'1!/'.-).<!02%'1.0%)7'!

0;;4,,4-0%)4.!+*%!30)2'-Q!R&'!:4,0.!).!5*'(%)4.!:0(!0//01'.%28!0%!1)(@!314,!0.!

0+*()7'!/01%.'1!0%!&4,'Q!B4:'7'1!%&)(!)(!.4%!4.28!0+4*%!%&'!.''-(!43!).-)7)-*02!

/0%)'.%(!0(!%&'('!,08!),/).<'!*/4.!%&'!.''-(!43!/01%.'1(P!41!:)-'1!30,)28Q!I!&07'!

;4.()-'1'-!%&'!/4()%)4.!43!z'.0!NDYWO!341!'L0,/2'C!0!-0*<&%'1!).!&'1!XFP(!:)%&!0.!

42-'1!&*(+0.-!:&4!3'2%!(&'!-)-!.4%!&07'!%&'!1'(4*1;'(!%4!;01'!341!&'1![4%&'1!S24!

N6F"O!34224:).<!&'1!-)(;&01<'!314,!&4(/)%02!N(''!XQUOQ!b')%&!N6WUO!:0(!&07).<!0!

,41'!-)33);*2%!(%1*<<2'!03%'1!&'!(*33'1'-!0!(%14@'C!+').<!&),('23!%&'!;01'1!43!&)(!:)3'C!

:&4!&0-!-','.%)0Q!R&'!(4;)02!:41@'1!&0-!%4!%18!%4!,''%!+4%&!%&')1!.''-(!341!0!

-)33'1'.%!%8/'!43!;01'!/4(%J-)(;&01<'Q!

!

Tension 2: Rapid patient turnover versus forming relationships

R&)(!/14+2',0%);!01'0!:0(!244@'-!0%!).!,41'!-'%0)2!1'<01-).<!(4;)02!:41@'1(!0.-!

4%&'1!/143'(()4.02(!).!GQKQ"!0+47'Q!!A4;)02!:41@'1(!1'/41%'-!0(('(().<!42-'1!

/0%)'.%(!%&0%!%&'8!&0-!.4%!+''.!0+2'!%4!,''%!30;'!%4!30;'Q!

!

S41!%&')1!/01%C!(4,'!43!%&'!*('1!0.-!;01'1!/01%);)/0.%(!<07'!%&'!),/1'(()4.!43!not!

&07).<!341,'-!/14-*;%)7'!1'20%)4.(&)/(!:)%&!%&')1!(4;)02!:41@'1C!+';0*('!314,!%&')1!

/'1(/';%)7'(!%&'!;4.%0;%!&0-!+''.!30)128!,).),02Q!R&'!(4;)02!:41@'1(!0.-!4%&'1!

/143'(()4.02(!02(4!-)(;*(('-!&4:!%&'!(/''-)'1!%1'0%,'.%!43!/0%)'.%(C!0.-!(&41%0<'!

43!%),'!%&'1'!:0(!%4!(/'.-!:)%&!%&',!0(!0!1'(*2%C!:0(!),/0;%).<!*/4.!%&')1!0+)2)%8!%4!

341,!1'20%)4.(&)/(!0.-!%4!+';4,'!30,)2)01!:)%&!/0%)'.%(!0(!/'4/2'Q!R&)(!:0(!

0--)%)4.0228!10)('-!0(!0-7'1('28!033';%).<!V4+!(0%)(30;%)4.!).!%&'!&4(/)%02Q!

!!

Tension 3: Multidisciplinary working versus promotion of the social model

A4;)02!:41@'1(!;4.7'8'-!0!('.('!43!+').<!.4%)4.0228!/01%!43!%&'!:)-'1!).%'1J

/143'(()4.02!%'0,!8'%!43%'.!c2'3%!4*%!43!%&'!244/P!02%4<'%&'1!41!0(@'-!341!)./*%!0%!%&'!

c20(%!,).*%'PQ!f&'.!%&'8!:'1'!).;2*-'-!)%!:0(!%&'.!&01-!341!(4;)02!:41@'1(!%4!

+140-'.!%&'!34;*(!43!%&'!%'0,!314,!/*1'28!;4.()-'10%)4.!43!c,'-);02P!;4.-)%)4.(!43!

! "#H

%&'!/0%)'.%(Q!R&)(!%'.()4.!(&4*2-!/'1&0/(!+'!'L/1'(('-!0(!0!;4.%).**,!+';0*('!I!

&0-!%&'!),/1'(()4.!%&0%!(4,'!(4;)02!:41@'1(!)-'.%)3)'-!%4!0!<1'0%'1!'L%'.%!%&0.!

4%&'1(!:)%&!&'02%&!/143'(()4.02(Q!!

!

$.!YR!;4,/20).'-!0+4*%!%&'!0+('.;'!43!0!(4;)02!,4-'2!).!%&'!4/'10%)4.!43!

-)(;&01<'Q!R&'!(4;)02!:41@'1(!;4.;*11'-!02%&4*<&!4.'!43!%&',!%02@'-!0+4*%!4%&'1!

/143'(()4.02(!+').<!,)(%0@'.!341!(4;)02!:41@'1(!-*1).<!0(('((,'.%(T!

!

S/W 2T!m$.-!%&'!-*/2);0%)4.!).!0(('((,'.%!d!84*P1'!0:01'!%&0%!%&'8P7'!/14+0+28!(''.!(4,'4.'!'2('C!%&'8!43%'.!%&).@!)%P(!%&'!(4;)02!:41@'1!0.-!)%P(!%&'!YR!41!-)(;&01<'!2)0)(4.C!0.-!%&'!.*1('(!&07'!-4.'!%&')1!0(('((,'.%Q!!S/W 4T!R&0%!,)<&%!+'!0!<44-!%&).<!0(!%&0%!,)<&%!).-);0%'!/'4/2'!01'!+140-'.).<!%&')1!/143'(()4.02!+4*.-01)'(!).%4!4*1!%'11)%418!0.-!&07).<!0!:)-'1!0//1';)0%)4.!43!%&'!(4;)02!;4.%'L%Qp!

B4:'7'1!%&'!20%%'1!;4,,'.%!:0(!,0-'!%4!0!1)//2'!43!20*<&%'1!:)%&).!%&'!<14*/C!0.-!

,)<&%!&07'!+''.!(/4@'.!c:)%&!%4.<*'!).!;&''@PQ!

!

R&'!4/'10%)4.!43!%&'!(4;)02!,4-'2!)(!3*1%&'1!-)(;*(('-!*.-'1!WFQHQ"!0+47'!0.-!)(!0.!

0(/';%!43!%&'!.'L%!;24('28!1'20%'-!%'.()4.Q!

!

Tension 4: Close co-operation with health versus advocacy

I.!%&'!34;*(!<14*/!-)(;*(()4.C!(4;)02!:41@'1(!(/4@'!43!.4%!2)@).<!m;4.32);%p!+*%!

.''-).<!%4!+'!m0(('1%)7'p!0.-!m;4.3)-'.%pC!/20;).<!%&'!('17);'!*('1!0%!%&'!341'314.%!43!

%&')1!-'02).<(!41!.'<4%)0%)4.(!:)%&!&'02%&!(%033Q!9'7'1%&'2'((!)%!,*(%!+'!'L%1','28!

-)33);*2%!%4!1',0).!0!%1*(%'-!c%'0,!/208'1P!).!%&'!,*2%)-)(;)/2).018!<14*/!:&)2'!

0-74;0%).<!341!%&'!/0%)'.%C!/01%);*20128!014*.-!;4.%'.%)4*(!)((*'(C!0(!-'(;1)+'-!+8!0!

3':!43!%&'!(4;)02!:41@'1(Q!I!:4*2-!01<*'!%&0%!%&'!7'18!%'1,!c,*2%)-)(;)/2).018P!)(!0!

,)(.4,'1Q!R&'!(4J;022'-!%'0,!)(!'L/'1)'.;'-!+8!%&'!(4;)02!:41@'1!7'18!43%'.!0(!

(4;)02!;01'!c<103%'-P!4.%4!%&'!341*,!341!&'02%&!-)(;)/2).'(!41!&'02%&!7'1(*(!(4;)02!

('17);'(!J!m*(!0.-!%&',p!0(!0!-4;%41!/01%);)/0.%!/*%!)%Q!I.!%&)(!'.7)14.,'.%C!%&'!().<2'!

(4;)02!:41@'1!;0.!3''2!1'20%)7'28!/4:'12'((Q!='208'-!-)(;&01<'!2'<)(20%)4.!&0(!

-'%'1,).'-!%&0%!4.'!<14*/!43!/0%)'.%(!:&4!01'!:0)%).<!341!('17);'(C!(%)22!4;;*/8).<!0!

+'-C!01'!%&'!c1'(/4.()+)2)%8P!43!(4;)02!('17);'(Q!A4;)02!:41@!/01%);)/0.%(!1'3'11'-!%4!0!

.'<0%)7'!0%%)%*-'!%4:01-(!%&4('!0:0)%).<!('17);'(!341!24.<!/'1)4-(!4.!%&'!:01-(!0.-!

4%&'1!1'('01;&!&0(!)-'.%)3)'-!0!24((!43!).%'1'(%!314,!.*1().<!(%033!).!42-'1!/0%)'.%(!

0(('(('-!0(!1'5*)1).<!1'()-'.%)02!41!.*1().<!;01'!N>&)22)/(!0.-!f0%'1(4.C!"FF"TWZ#OQ!

!

! "#U

Tension 5: Information gathering on behalf of the agency AND user/carer

information need!!

I.!%&'!&4(/)%02!('%%).<!/0%)'.%(!1'5*)1'!,'-);02!).341,0%)4.!0+4*%!%&')1!;4.-)%)4.!0.-!

&4:!%4!(/''-!41!,0).%0).!1';47'18!).!0--)%)4.02!%4!(4;)02!;01'!@.4:2'-<'!0+4*%!

/4(%J-)(;&01<'!('17);'(Q!A4;)02!:41@'1(!,08!&07'!0!142'!).!'L/20).).<!,'-);02!

).341,0%)4.!%4!*('1(!0.-!;01'1(!41!0-74;0%).<!341!%&',!%4!1';')7'!;201)3);0%)4.!314,!

&'02%&!/'1(4..'2!N[;]'4-!0.-!^8:0%'1(C!"FFFOQ!$%!%&'!(0,'!%),'!&4(/)%02!(4;)02!

:41@'1(!&07'!%4!;422';%!/'1(4.02!-'%0)2(!0+4*%!*('1(!0(!/01%!43!%&')1!0(('((,'.%Q!

R&)(!&0(!+''.!-)(;*(('-!).!%&'!/1'7)4*(!;&0/%'1!*.-'1!GQXQ#Q!!

f&)2'!,4(%!('17);'!*('1(!0.-!%&')1!;01'1(!(0)-!%&0%!%&'8!-)-!.4%!&07'!0!/14+2',!:)%&!

<)7).<!).341,0%)4.!0+4*%!%&',('27'(!341!0(('((,'.%!/*1/4('(C!(4;)02!:41@'1(!34*.-!

<0%&'1).<!%&)(!0.-!'.(*1).<!%&0%!022!1'2'70.%!341,(!:'1'!3)22'-!).!%4!+'!+*1-'.(4,'!

4.!%&'!:&42'C!'(/';)0228!:&'.!)%!&0-!%4!+'!-4.'!:)%&).!%)<&%!%),'(;02'(Q!R&)(!,08!

02(4!+'!'L/1'(('-!).!%'1,(!43!0!;4.%).**,!0(!)%!:0(!0//01'.%!%&0%!(4,'!(4;)02!

:41@'1(!34*.-!0-,).)(%10%)4.!0.-!0((4;)0%'-!;4,/*%'1!%';&.424<8!'0()'1!%&0.!

4%&'1(M!'5*0228!(4,'!('','-!,41'!;4,,)%%'-!41!0%!'0('!:)%&!%&')1!142'!0(!

-)(/'.('1(!43!).341,0%)4.Q!D01'1!/01%);)/0.%(C!).;2*-).<!]8-)0!NDFKO!0.-!R'1'(0P(!

-0*<&%'1!NDFGOC!1'/41%'-!%&0%!@.4:2'-<'!43!('17);'(!%&'8!&0-!<2'0.'-!:0(!

).0-'5*0%'C!/01%);*20128!).!R'1'(0P(!;0('!:&'.!(&'!1'%*1.'-!&4,'!314,!&4(/)%02!

:)%&!0!;4,/2'L!;01'!/0;@0<'Q!S41%*.0%'28!%&'1'!:'1'!1'20%)7'(!).7427'-!).!+4%&!

%&'('!()%*0%)4.(!%&0%!:'1'!01%);*20%'!0.-!0+2'!%4!,0@'!%'2'/&4.'!;022(!4.!%&'!('17);'!

*('1P(!+'&023Q!

!

Other tensions!

D2'0128!%&'!1'(%!43!%&'!/4).%(!2)(%'-!).!R0+2'!WFQW!0+47'!;4*2-!0//28!%4!(4;)02!:41@!).!

<'.'102C!02%&4*<&!time pressuresC!<)7'.!%&'!2'<)(20%)7'!1'5*)1','.%(!014*.-!

-'208'-!-)(;&01<'C!0.-!20;@!43!user involvement!/01%);*20128!),/0;%!4.!&4(/)%02!

(4;)02!:41@Q!R&'!.''-!%4!*.-'1%0@'!risk!management!34224:).<!0.!'/)(4-'!43!

*('1P(!)22!&'02%&!;0.!;2'0128!02(4!+'!/'1%).'.%!%4!%&'!&4(/)%02!('%%).<!0.-!:0(!

-)(;*(('-!0+47'Q!Expectations!43!/0%)'.%(!0.-!%&')1!30,)2)'(!43!%&'!42-'1!('17);'!

*('1P(!/&8();02!1';47'18!0.-!0+)2)%8!%4!,0.0<'!0%!&4,'!34224:).<!-)(;&01<'!:'1'!

(4,'%),'(!*.1'02)(%);!:'1'!02(4!-)(;*(('-!).!D&0/%'1!GQ!I%!;0.!+'!/01%!43!%&'!(4;)02!

:41@!142'!%4!,0.0<'!%&'('!'L/';%0%)4.(!).!;4.V*.;%)4.!:)%&!*('1(!0.-!;01'1(Q!

B4:'7'1!%&'!'7'1J5*);@'.).<!/0;'!43!-)(;&01<'!0(!-)(;*(('-!0+47'!;0.!1'(*2%!).!

*.1'02)(%);!professional!'L/';%0%)4.(!1'(*2%).<!).!(/''-8!-)(;&01<'(C!0.L)'%8!341!%&'!

42-'1!('17);'!*('1C!'7'.!1'J0-,)(()4.(!0(!1'/41%'-!).!D&0/%'1(!Z!0.-!GQ!

! "#K

!

Further reflections

Y.!1'32';%)4.!c+020.;).<!.''-(P!41!c1';4.;)2).<!%'.()4.(P!),/2)'(!%&0%!%&'!(4;)02!

:41@'1!)(!30;'-!:)%&!%:4!4//4()%'!/4()%)4.(!41!;4.32);%).<!-',0.-(Q!I.!'(('.;'C!0(!

%&)(!(%*-8!&0(!(&4:.C!)%!)(!01<*0+28!,41'!;4,/2'L!%&0.!%&0%Q!I!(*<<'(%!%&0%!%&'!

c+020.;).<P!41!c1';4.;)2).<P!)(!,41'!0@).!%4!%&'!0;%)4.(!43!0!V*<<2'1!0%%',/%).<!%4!@''/!

('7'102!)%',(!c).!%&'!0)1PC!:&)2'!1'(/4.-).<!%4!/1'((*1'(!314,!-)33'1'.%!-)1';%)4.(C!

02+')%!%&'!V*<<2'1P(!(@)22!)(!*(*0228!341!%&'!/*1/4('!43!'.%'1%0).,'.%Q!R&'!,'%0/&41!)(!

02(4!43%!*('-!).!1'20%)4.!%4!:4,'.!0.-!/01%);*20128!1'<01-).<!:41@).<!,4%&'1(!41!

;01'1(!:&4!&07'!,*2%)/2'!;4,/'%).<!-',0.-(!*/4.!%&')1!%),'Q!S)<*1'!WFQ"!+'24:!)(!

0!-)0<10,,0%);!1'/1'('.%0%)4.!43!%&'!(4;)02!:41@'1!'.<0<'-!).!.'<4%)0%).<!)((*'(!

:)%&!*('1(!0.-!;01'1(!0<0).(%!0!+0;@<14*.-!43!,*2%)/2'!-',0.-(Q!!

!

I.!%&'!-)0<10,C!S)<*1'!WFQ"!%&'!4*%'1!310<,'.%'-!;)1;2'!1'/1'('.%(!%&'!'L%'1.02!

,)2)'*!).!:&);&!%&'!1'20%)4.(&)/!+'%:''.!('17);'!*('1\0.-!41!%&')1!;01'1!0.-!%&'!

0224;0%'-!(4;)02!:41@'1!4/'10%'C!%&'!0114:(!).-);0%).<!),/0;%!*/4.!%&0%!1'20%)4.(&)/Q!

I.'7)%0+28!341!%&'!(0@'!43!1'-*;).<!;4,/2'L)%8C!(8,+42);!-)0<10,,0%);!

1'/1'('.%0%)4.!;0.!<)7'!%&'!),/1'(()4.!%&0%!(4,'%&).<!)(!(),/2'!41!(%10)<&%341:01-!

).!1'02!2)3'C!:&'.!%&'!4//4()%'!,08!/'1%0).Q!R&'!).(%)%*%)4.!43!%&'!24;02!0*%&41)%8!-4'(!

/147)-'!(*//41%!,';&0.)(,(!).!%&'!341,!43!(*/'17)()4.!0.-!/''1!(*//41%C!0.-!(4;)02!

.'%:41@(!;0.!'5*0228!/147)-'!;4,341%!0.-!/14-*;%)7'!1'20%)4.(&)/(!341!('17);'!*('1(Q!

S41!%&'!).-)7)-*02C!+4%&!:41@'1!0.-!*('1!&07'!/'1(4.02!0.-!/143'(()4.02!'%&);(!0.-!

702*'(!%&0%!%&'8!+1).<!).!0--)%)4.!%4!%&')1!/'1(4.02!;&010;%'1)(%);(!43!<'.-'1C!10;'C!

0.-!).;4,'Q!!

!

! "#X

!

Figure 10.2: Pressures & tensions for hospital social work

[=R!u![*2%)-)(;)/2).018!%'0,!:41@).<!:)%&!42-'1!/'4/2'!).!&4(/)%02(!(*;&!0(!%&'!4.'!*/4.!:&);&!%&'!(%*-8!:0(!+0('-Q

! "#Z

What can social workers do!%4!3).-!0!:08!%&14*<&!%&'!;&04(!0.-!1';4.;)2'!%&'('!

%'.()4.(k!I%!&0(!+''.!(&4:.!%&0%!).!)%('23!30;).<!0.-!-'02).<!:)%&!/'1/'%*02!%'.()4.(!

0%!:41@!0(!4*%2).'-!0+47'!;0.!;0*('!(%1'((!N^0224;&C!>0&2!0.-![;]'0.C!WGGZOQ!

>4(%2'!244@(!%4!(4;)02!:41@!%10).).<!%4!/1'/01'!3*%*1'!/10;%)%)4.'1(!0.-!341!c+140-'1!

0//140;&'(P!%4!:41@!c:)%&).!;4,,*.)%)'(!0.-!0;14((!%'0,(!0.-!.'%:41@(P!N>4(%2'C!

"FF"T#HKOQ!I.!'L0,).).<!%&'!(&01'-!)((*'(!+'%:''.!(4;)02!:41@'1(!0.-!*('1\;01'1(C!

%&'1'!01'!;4,,4.!;0*('(!341!+4%&!/01%)'(!%4!*.)%'!0.-!341,!022)0.;'(!0(!&0(!43%'.!

+''.!;022'-!341!N'Q<Q!=4,).'22)C!"FFHOQ!R&'!5*'(%)4.!)(!:&'%&'1!).!0!&4(/)%02!

'(%0+2)(&,'.%!:)%&!(4;)02!:41@'1(!'33';%)7'28!30;).<!%:4!-4,).0.%!&)'101;&)'(!43!%&'!

9BA!0.-!24;02!<47'1.,'.%C!&4:!3'0()+2'!%&0%!)(!0.-!/01%);*20128!*.)%).<!:)%&!310)2'1!

42-'1!/'4/2'!:&4!,08!+'!4//1'(('-!3*1%&'1!+8!-)(0+)2)%8C!10;'C!;20((C!<'.-'1C!

1'2)<)4.!41!('L*02!41)'.%0%)4.Q!9'7'1%&'2'((!0(!&0(!+''.!01<*'-!+8!S4*;0*2%!

N?0+).4:C!WGZHO!0.-!4%&'1(C!:&'1'!/4:'1!)(!24;0%'-!%&'1'!)(!1'()(%0.;'C!0.-!(4!I!

1'%*1.'-!%4!%&'!-0%0!%4!3).-!'L0,/2'(!43!/4()%)7'!(%'/(!(4;)02!:41@'1(!3'2%!%&'8!:'1'!

%0@).<C!.4!,0%%'1!&4:!(,022!41!).()<.)3);0.%Q!R&'!'(('.;'!43!:&0%!%&'8!(0)-!%&'8!

:'1'!0+2'!%4!0;&)'7'C!.4%!02:08(!0.-!/'1&0/(!.4%!43%'.C!)(!/1'('.%'-!).!%&'!

/&'.4,'.4<10/&8!S)<*1'!WFQ#!+'24:Q!

!

!

!

!

!

! !

! "#G

Informing care management with social work

Holism-seeing the whole person

Being confident and assertive with other professionals

Building and maintaining relationships with users and

carers where possible, in spite of the ‘paperwork’:

!! Being kind

!! Being there, spending time when you can

!! Being a ‘name’ to contact

!! Putting ‘the relationship’ at the forefront

Prompting and questioning re: consultation with

patients, with the multi-disciplinary team.

Taking risks with risky situations where it is user choice.

Discussing oppressive practices with management and

Health.!

Figure 10.3 Phenomenography of social workers’ reflections on their positive contribution to the discharge process

!

WFQX! Hospital social work and theoretical models of practice

!

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!

! "HF

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WWQ#! The study and its predecessors: some key issues!

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11.4 Achievement of research aims

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Appendix 1 – Personal afterward !

From practitioner to researcher, carer and service user, but always a tea drinker

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Appendix 2 – Case examples !

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Case example 2: Harry (U10) and Lydia (CO6)

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! "ZZ

Appendix 3 - Research project milestones !

R&)(!%0+2'!;47'1(!%&'!/'1)4-!314,!%&'!(%01%!43!%&'!1'('01;&!/14V';%!%4!%&'!'.-!43!-0%0!<'.'10%)4.!!

Action Background events Date

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! S'+1*018J[01;&!"FFH!

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!

!

! "ZG

Appendix 4 - Patients’ semi-structured interview schedule

Introduction/experience of hospital

!! S)1(%28C!&4:!24.<!&07'!84*!+''.!).!&4(/)%02k!B4:!&0(!)%!+''.!341!84*k!

!! I3!84*!@.4:C!;0.!84*!%'22!,'!:&'1'!84*!:)22!+'!<4).<!:&'.!84*!2'07'k!

!! f&'.!-4!84*!'L/';%!%4!<4k

!! A*//QhQ!D4*2-!84*!%'22!,'!0%!:&0%!(%0<'!84*!(%01%'-!%&).@).<!0+4*%!;4,).<!4*%!43!&4(/)%02kNprompt: on admission > not at all)!

!! NA*//QhQ!I3!0//14/1)0%'T!f&0%!&0(!)%!3'2%!2)@'!341!84*!%4!:0)%!4.!%&'!:01-!%4!+'!-)(;&01<'-kO!

!

Discharge process

!! IP,!(*1'!84*!:)22!&07'!&0-!0!%02@!:)%&!(%033\(4,'4.'!4*%()-'!31)'.-(\30,)28!0+4*%!%&'!/20.(!341!84*!;4,).<!4*%!43!&4(/)%02Q!=4!84*!@.4:!:&4!%&'('!/'4/2'!:'1'k!(Prompt: nurse/o.t./physio/social worker)!

!0O!I3!*.;'1%0).\-'.8!(\:!).7427','.%O!

!! f&0%!(41%(!43!%&).<(!-)-!84*!%02@!%4!%&',!0+4*%k!

!! B4:!-)-!84*!3''2!0+4*%!%&'('!-)(;*(()4.(k!!!Y?!!+O!I3!1',',+'1!(4;)02!:41@!).7427','.%!

!! f&0%!-)-!84*!%&).@!0+4*%!%&'!&'2/!84*!1';')7'-!314,!(4;)02!:41@'1k!(Prompt: relationship, planning services, help re adjusting to coping with new situation?)

!! IP,!02(4!).%'1'(%'-!%4!@.4:!84*1!4/).)4.!4.!%&'!:08!-';)()4.(!:'1'!,0-'!0+4*%!84*1!3*%*1'C!)3!84*!3''2!0+2'!%4!(08!(4,'%&).<!0+4*%!%&0%k!!NPrompt : enough time, information, consultation – i.e. were you able to express your views and preferences? Did you feel you were listened to? Did you feel you had any influence on what has been arranged for when you come out of hospital?)!

!

Conclusion

!! w4*!-4.P%!&07'!%4!0.(:'1!%&)(!43!;4*1('!+*%!)(!%&'1'!0.8%&).<!0+4*%!%&'!/20..).<!341!84*!%4!2'07'!&4(/)%02!%&0%!84*!:4*2-!&07'!2)@'!%4!&07'!+''.!-4.'!-)33'1'.%28k!

!! I!:0(!02(4!:4.-'1).<!&4:!84*!01'!3''2).<!0+4*%!2'07).<!%&)(!:01-!0.-!<4).<!%4!QQk!!

And finally!

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!! I(!%&'1'!0.8%&).<!84*P7'!(0)-!%&0%!84*!:4*2-!2)@'!%4!;&0.<'k!

!! $.8%&).<!84*!:0.%!%0@'.!4*%\-'2'%'-k!

!! D0.!I!02(4!0(@!84*1!/'1,)(()4.!).!*().<!%&'!;4.%'.%(!4.!%0/'!43!%&)(!).%'17)':!341!,8!1'('01;&!/14V';%k!$:0)%!1'(/4.('Q!

!

R&0.@!84*!7'18!,*;&!341!0<1'').<!%4!0.(:'1!,8!5*'(%)4.(!0.-!341!84*1!;4.%1)+*%)4.!%4!%&'!(%*-8C!

! "GF

Appendix 5 - Carers semi-structured interview schedule

Introduction/experience of hospital

!! S)1(%28C!&4:!&0(!)%!+''.!341!84*C!:)%&!eN&'1'03%'1!1'3'11'-!%4!0(T!yO!+').<!).!&4(/)%02k!

!! B4:!-4!84*!%&).@!y!&0(!34*.-!)%k!N>14,/%T!'(/';)0228!)3!%&'8P7'!&0-!%4!:0)%!341!('17);'(!'%;QO!

!! I3!84*!@.4:C!;0.!84*!%'22!,'!:&'1'!y!:)22!+'!<4).<!:&'.!%&'8!2'07'k!

!! f&'.!-4!84*!'L/';%!y!%4!<4k!!

Discharge process

!! D4*2-!84*!%'22!,'!0%!:&0%!(%0<'!84*!(%01%'-!%&).@).<!0+4*%!/20..).<!341!y!;4,).<!4*%!43!&4(/)%02k!N>14,/%T!4.!0-,)(()4.!x!.4%!0%!022O!

!! IP,!(*1'!84*!:)22!&07'!&0-!0!%02@!:)%&!(%033\(4,'4.'!4*%()-'!31)'.-(\30,)28!0+4*%!%&'!/20.(!341!y!;4,).<!4*%!43!&4(/)%02Q!=4!84*!@.4:!:&4!%&'('!/'4/2'!:'1'k!NPrompt: D./nurse/o.t./physio/social worker)!

!0O!I3!*.;'1%0).\-'.8!(\:!).7427','.%O!

!! f&0%!(41%(!43!%&).<(!-)-!84*!%02@!%4!%&',!0+4*%k!

!! B4:!-)-!84*!3''2!0+4*%!%&'('!-)(;*(()4.(k!!!Y?!!+O!I3!1',',+'1!(4;)02!:41@!).7427','.%!

!! f&0%!-)-!84*!%&).@!0+4*%!%&'!&'2/!0Q!1';')7'-!314,!(4;)02!:41@'1k!NPrompt: relationship, planning services, and help re adjusting to coping with new situation?)!

!! IP,!02(4!).%'1'(%'-!%4!@.4:!84*1!4/).)4.!4.!%&'!:08!-';)()4.(!:'1'!,0-'!0+4*%!yP(!3*%*1'C!)3!84*!3''2!0+2'!%4!(08!(4,'%&).<!0+4*%!%&0%k!!(Prompt: enough time, information, consultation – i.e. was X able to express their views and preferences? Did you feel X was listened to? Did you feel X had any influence on what has been arranged for coming out of hospital?)!

!! f&0%!0+4*%!%&'!:08!84*!:'1'!%1'0%'-!0(!0!;01'1k!!NPrompt: as last question aboveO!!

Conclusion

!! w4*!-4.P%!&07'!%4!0.(:'1!%&)(!43!;4*1('!+*%!)(!%&'1'!0.8%&).<!0+4*%!%&'!/20..).<!341!y!%4!2'07'!&4(/)%02!%&0%!84*!:4*2-!&07'!2)@'!%4!&07'!+''.!-4.'!-)33'1'.%28k!

!! I!:0(!02(4!:4.-'1).<!&4:!84*!01'!3''2).<!0+4*%!y!2'07).<!%&)(!:01-!0.-!<4).<!%4!ek!

!And finally

!! I(!%&'1'!0.8%&).<!'2('!84*!:4*2-!2)@'!%4!0--!%4!:&0%!84*!&07'!(0)-!).!4*1!-)(;*(()4.!(4!301k!

!! I(!%&'1'!0.8%&).<!%&0%!84*!&07'!(0)-!%4!,'!%&0%!84*!:4*2-!2)@'!%4!;&0.<'k!

!! $.8%&).<!84*!:0.%!-'2'%'-k!

!! D0.!I!02(4!0(@!84*1!/'1,)(()4.!).!*().<!%&'!;4.%'.%(!4.!%0/'C!43!%&)(!).%'17)':!341!,8!1'('01;&!/14V';%k!$:0)%!1'(/4.('!!

R&0.@!84*!7'18!,*;&!341!0<1'').<!%4!0.(:'1!,8!5*'(%)4.(!0.-!341!84*1!;4.%1)+*%)4.!%4!%&'!(%*-8Q!

! "GW

Appendix 6 - Staff interview agenda for consultation with participants

!

Joint working

!! ?'20%)4.(&)/(!+'%:''.!/143'(()4.02!<14*/(!:41@).<!:)%&!42-'1!/'4/2'!).!%&'!&4(/)%02!

!! ?'20%)4.(&)/(!+'%:''.!0+47'!<14*/(!0.-!/1),018!;01'!

!! _)':(!4.!&4:!).-)7)-*02!/143'(()4.02!;4.%1)+*%)4.(!01'!702*'-!).!,*2%)-)(;)/2).018!%'0,:41@!:)%&!42-'1!)./0%)'.%(Q!

!

The discharge process for older people.

!! E33';%(!*/4.!42-'1!/'4/2'!:&4!:0)%!%4!+'!-)(;&01<'-!&4(/)%02Q!

!! R&'!'L%'.%!%4!:&);&!42-'1!/0%)'.%(!01'!;4.(*2%'-!).!-)(;&01<'!/20..).<Q!

!! R&'!'L%'.%!%4!:&);&!).341,02!;01'1(!01'!;4.(*2%'-!0+4*%!-)(;&01<'!/20.(!341!%&'!42-'1!/'1(4.!%&'8!244@!03%'1Q!

!! _)':(!4.!%&'!;4.('5*'.;'(!43!%&'!c-'208'-!-)(;&01<'P!2'<)(20%)4.!*/4.!42-'1!/0%)'.%(Q!

!! _)':(!43!%&'!),/0;%!43!%&'!0+47'!2'<)(20%)4.!*/4.!&4(/)%02!\!(4;)02!:41@!(%033!

!! f&0%!;4*2-!+'!),/147'-!341!42-'1!/'4/2'!2'07).<!&4(/)%02k!!

Health and social care

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!! Y/).)4.(!4.!:&0%!).-)7)-*02!/143'(()4.(!&07'!%4!433'1!%4!%&'!-)(;&01<'!/14;'((Q!!

Any other issues of importance to the group not covered in the above?

!

!

$//147'-!+8!y!9BA!]4;02!?'('01;&!E%&);(!D4,,)%%''!g*28!"FFH!

Sue Fowler >4(%<10-!1'('01;&!(%*-'.%C!A;&442!43!B'02%&C!E-*;0%)4.!aD4,,*.)%8!A%*-)'(!941%&*,+1)0!6.)7'1()%8!

!

! "G"

GROUND RULES FOR DISCUSSION GROUP

!

!! 94!1)<&%!41!:14.<!0.(:'1(!!

!! $22!;4.%1)+*%)4.(!01'!'5*02!a!%4!+'!1'(/';%'-!!

!! f&0%'7'1!)(!(0)-!,*(%!+'!@'/%!0.4.8,4*(!!

!! $<1'','.%!4.!)((*'(!.4%!1'5*)1'-C!!!

!! a!I%(!4@!)3!%&'1'!)(!0!;4.('.(*(!%44!!

!! E0;&!/'1(4.!31''!.4%!%4!1'(/4.-!%4!0.8!,0%%'1!!

!! [4-'10%41!&0(!%4!+'!),/01%)02o!!

!! S41!%&'!,)@'!a!%10.(;1)+'1!4.'!/'1(4.!%4!(/'0@!0%!0!%),'!)-'0228o!!

!

! "G#

Appendix 7 – Additional information sheet for users and carers !

Research Project: YOUR

EXPERIENCES OF LEAVING

HOSPITAL

Q.What am I being asked to do?

Would you be able to give a little of your time talking to

a researcher; to help us find out what it is like for

someone like you, or the person you care for, to come

out of hospital? At a time and place to suit you, you will

be asked if you agree to answer a few questions about

your experiences, for up to about 45 minutes.

!

Q . By who?

Research student Sue Fowler will be conducting the

interviews. She has been a social worker for 30 years

and is now studying for a PhD at Northumbria

University. She has an honorary contract with X

Hospitals Trust who with the Research Ethics

Committee and X Council have approved the project.

Q . What if I change my mind?

Taking part has to be entirely your decision, and this

will be checked at every stage, to make sure you are

comfortable about everything. You are free not to

! "GH

answer any question you don’t like AND to withdraw

any time without giving a reason

Q . Will my response be kept anonymous?

Yes - your name, address and personal details will not

be linked to the discussion recording, which will be

carefully stored and destroyed when the study is

finished.

Q . What is it for?

It is hoped that a report from the study will eventually

be published, in various formats, so that health and

social care workers and the policymakers can learn from

the views of older people, carers & key stakeholders.

FOR COMMENTS, QUESTIONS OR COMPLAINTS

Research Investigator

Name: A*'!S4:2'1!!i>4(%<10-*0%'!1'('01;&!(%*-'.%j!!Sponsor: A;&442!43!B'02%&C!E-*;0%)4.!0.-!D4,,*.)%8!A%*-)'(C!941%&*,+1)0!6.)7'1()%8C!B"WHC!D40;&!]0.'!D0,/*(!E0(%C!9':;0(%2'!*/4.!R8.'C!

! "GU

9EX!Xy$!!Contact telephone no:

!Email:!(*'34:2'1}4.'%'2Q;4,!!!!Supervisor

Name: >143'((41!=07)-!A%0.2'8!!Address:!941%&*,+1)0!6.)7'1()%8!$(!0+47'Q!!Contact telephone no: 0191 215 6261

Email: -07)-Q(%0.2'8}*..Q0;Q*@!

! "GK

Appendix 8 – Documentation for social workers giving assent on behalf of service users !

A;&442!43!B'02%&C!E-*;0%)4.!0.-!D4,,*.)%8!A%*-)'(C!941%&*,+1)0!6.)7'1()%8C!

B"WHC!D40;&!]0.'!D0,/*(!E0(%C!9':;0(%2'!*/4.!R8.'C!

9EX!Xy$!!

R'2T!!!

E,0)2T!(*'34:2'1}4.'%'2Q;4, !

Dear .. Re: Research Study: The role of social work in hospital discharge of older people eeeeeQQC!:&4!)(!0!('17);'!*('1!@.4:.!%4!84*C!&0(!0!;24('!1'20%)7'\;01'1!:&4!)(!+').<!;4.()-'1'-!341!).;2*()4.!4.!0!742*.%018!+0()(!).!%&'!0+47'!(%*-8Q!!`)7'.!%&0%!%&)(!('17);'!*('1!)(!-'','-!0(!2)@'28!%4!&07'!-)33);*2%)'(!).!<)7).<!).341,'-!;4.('.%!0.-!).!<)7).<!/'1,)(()4.!02(4!341!%&')1!1'20%)7'\;01'1!%4!%0@'!/01%!J!34224:).<!1'('01;&!'%&);(!/42);8!0.-!+'(%!/10;%);'!J!I!:4*2-!+'!<10%'3*2!)3!84*!:4*2-!<)7'!84*1!4/).)4.!0(!%4!:&'%&'1!)%!)(!0//14/1)0%'!341!%&')1!1'20%)7'\;01'1eeee!%4!+'!0//140;&'-Q!!!

I.341,0%)4.!0+4*%!%&'!1'('01;&!0.-!:&0%!/01%);)/0%)4.!:4*2-!'.%0)2!341!eeeeQ!I(!0%%0;&'-Q!!Y.;'!84*!&07'!1'0-!%&)(!).341,0%)4.!/2'0('!;4*2-!84*!;4,/2'%'!%&'!'.;24('-!341,!).-);0%).<!84*1!4/).)4.!0+4*%!).7)%).<eeeQQ!/01%);)/0%)4.!0.-!1'%*1.!)%!%4!,'C!).!%&'!'.;24('-!A$EQ!!!!I3!84*!3''2!84*!.''-!3*1%&'1!).341,0%)4.!0+4*%!%&'!1'('01;&C!41!)3!84*!:4*2-!2)@'!%4!(''!%&'!).341,0%)4.!(&''%(!341!;01'1(\1'20%)7'(!/2'0('!;4.%0;%!,'C!!!!R&0.@).<!84*!).!0.%);)/0%)4.!43!84*1!&'2/Q!!w4*1(!().;'1'28!!A*'!S4:2'1!>4(%<10-*0%'!1'('01;&!(%*-'.%!!!!!

! "GX

INFORMATION SHEET/CONSENT FORM FOR STAFF GIVING ASSENT Study title: The role of social work in hospital discharge of older people !Purpose of the study!R&)(!(,022J(;02'!5*02)%0%)7'!1'('01;&!/14V';%!(''@(!%4!3).-!4*%!%&'!7)':(!43!42-'1!/'4/2'!0.-!%&')1!;01'1(\;24('!1'20%)7'!4.T!%&'!/14;'((!43!-)(;&01<'!314,!&4(/)%02C!&4:!;01'!:0(!0110.<'-!0.-!%&')1!4/).)4.!43!5*02)%8!43!('17);'(!0.-!4*%;4,'(Q!!Inclusion criteria >0%)'.%(!47'1!KU!8'01(!42-C!0.-!%&')1!;24('!1'20%)7'\;01'1!:&4!&07'!&0-!;4.%0;%!:)%&!0!(4;)02!;01'!,0.0<'1!41!(4;)02!:41@'1!1'<01-).<!-)(;&01<'!314,!y!B4(/)%02C!:&4!01'!0+2'!%4!<)7'!).341,'-!;4.('.%!%4!/01%);)/0%'C!:&4!01'!.4%!%'1,).0228!)22!41!&07'!('7'1'!;4,,*.);0%)4.!-)33);*2%)'(!0.-!:&4('!,'.%02!41!/&8();02!;4.-)%)4.!:4*2-!.4%!+'!&01,'-!+8!%0@).<!/01%Q!!Do relatives or carers have to take part?!R0@).<!/01%!).!%&'!1'('01;&!)(!'.%)1'28!742*.%018!0.-!;4.('.%!:)22!+'!1'!J;4.3)1,'-!0%!'7'18!(%0<'C!(4!%&0%!/01%);)/0.%(!;0.!:)%&-10:!0%!0.8!%),'!:)%&4*%!<)7).<!0!1'0(4.Q!>01%);)/0.%(!01'!0(@'-!%4!1'0-!0.!).341,0%)4.!(&''%!0.-!;4,/2'%'!0!;4.('.%!341,!)3!%&'8!:)(&!%4!+'!).;2*-'-!).!%&'!(%*-8!!!What will happen to participants? >01%);)/0.%(!01'!0(@'-!%4!1'(/4.-!%4!4.'!%0/'J1';41-'-!).%'17)':!:)%&!%&'!1'('01;&'1!%&0%!:)22!%0@'!014*.-!HU!,).*%'(C!&'2-!).!/1)70%'!0.-!%&'!/20;'!0.-!%),'!;0.!+'!0110.<'-!0%!%&'!/01%);)/0.%P(!;4.7'.)'.;'Q!R&'!).%'17)':(!01'!(',)J(%1*;%*1'-!0.-!).341,0.%(!:)22!+'!0(@'-!0+4*%!%&')1!'L/'1)'.;'(!0(!0!;01'1!41!;24('!1'20%)7'!43!0.!42-'1!/'1(4.!:&4!&0(!+''.!-)(;&01<'-!314,!&4(/)%02C!+*%!:)22!02(4!+'!<)7'.!%&'!;&0.;'!%4!%02@!0+4*%!0.8!4%&'1!,0%%'1(!0(!%&'8!:)(&Q!R&'('!).%'17)':(!:)22!%0@'!/20;'!314,!$*%*,.!"FFUQ!!!What are the possible disadvantages and risks of taking part?!$.(:'1).<!%&'!5*'(%)4.(!,08!+'!%)1).<C!02%&4*<&!0%!0.8!(%0<'!%&'!).%'17)':!;0.!+'!&02%'-Q!R&'1'!)(!%&'!/4(()+)2)%8!%&0%!%&'!).%'17)':(!:4*2-!+1).<!*/!('.()%)7'!)((*'(!%&0%!%&'!/01%);)/0.%!,08!:)(&!%4!-)(;*((!3*1%&'1C!).!:&);&!;0('!%),'!;0.!+'!('%J0()-'!341!%&)(Q!!!What are the possible benefits of taking part?!R&'!).341,0%)4.!:'!<'%!314,!%&)(!(%*-8!)(!-'()<.'-!%4!&'2/!*(!%4!*.-'1(%0.-!%&'!-)33);*2%)'(!0.-!)((*'(!%&0%!42-'1!/'4/2'!0.-!%&')1!;01'1(!&07'!03%'1!0!/'1)4-!).!&4(/)%02Q!I%!:)22!+'!7'18!*('3*2!341!%&4('!:&4!/20.!0.-!/147)-'!('17);'(!%4!@.4:!:&0%!)%!)(!2)@'!314,!%&'!1'20%)7'\;01'1P(!7)':/4).%Q!>01%);)/0.%(!,08!'7'.!3).-!)%!&'2/3*2!%4!'L/1'((!4/).)4.(!%4!0.!4*%()-'1!:&4!:)22!'.(*1'!%&0%!%&'8!:)22!+'!@'/%!;4.3)-'.%)02Q!6.341%*.0%'28!%&'1'!01'!.4!3).0.;)02!/08,'.%(!341!%0@).<!/01%Q!!!!What if something goes wrong?!I3!/01%);)/0.%(!01'!*.&0//8!0+4*%!0.8!/01%!43!%&'!).%'17)':C!%&'8!;0.!;4.%0;%!A*'!S4:2'1!41!(*/'17)(41!=07)-!A%0.2'8C!:&4!:'!:)22!-4!%&')1!+'(%!%4!1'-1'((!%&'!()%*0%)4.Q!!!R&'1'!01'!.4!(/';)02!;4,/'.(0%)4.!0110.<','.%(C!(&4*2-!/01%);)/0.%(!3''2!0-7'1('28!033';%'-C!+*%!)3!%&'8!:)(&!%4!;4,/20).C!41!&07'!0.8!;4.;'1.(!0+4*%!0.8!0(/';%!43!%&'!:08!%&'8!&07'!+''.!%1'0%'-!-*1).<!%&'!;4*1('!43!%&)(!(%*-8C!%&'!.41,02!90%)4.02!B'02%&!A'17);'!;4,/20).%(!,';&0.)(,(!:)22!+'!070)20+2'Q!!

! "GZ

Will my taking part in this study be kept confidential? $22!).341,0%)4.C!:&);&!)(!;422';%'-C!0+4*%!/01%);)/0.%(!-*1).<!%&'!;4*1('!43!%&'!1'('01;&!:)22!+'!@'/%!(%1);%28!;4.3)-'.%)02Q!!R0/'-!1';41-).<!43!%&'!).%'17)':(!:)22!+'!-'(%148'-!4.;'!0.028('-!0.-!.0,'(!41!0--1'(('(!:)22!.4%!+'!0%%0;&'-!%4!%0/'(!41!0.8!4%&'1!1';41-(Q What will happen to the results of the research study? Y.!(*;;'((3*2!;4,/2'%)4.!43!%&'!1'('01;&!/14V';%C!%&'!1'(*2%(!:)22!+'!070)20+2'!0%!%&'!941%&*,+1)0!6.)7'1()%8Q!A*+('5*'.%!/*+2);0%)4.!:)22!+'!(*+V';%!%4!/14;'-*1'(!).!%&'!0//14/1)0%'!V4*1.02Q!>01%);)/0.%(!:)22!.4%!+'!)-'.%)3)'-!).!0.8!1'/41%\/*+2);0%)4.Q!!Who is organising and funding the research? A*'!S4:2'1!)(!0!5*02)3)'-!(4;)02!:41@'1!:&4!&0(!/10;%)('-!341!"U!8'01(C!&0(!0!(4;)02!(;)'.;'!&4.4*1(!-'<1''C!0.![Q$QC!0.-!)(!;*11'.%28!0!3*22!%),'!>&=!(%*-'.%!*.-'1!0!(%*-'.%(&)/!(;&','!0%!%&'!941%&*,+1)0!6.)7'1()%8C!9':;0(%2'!*/4.!R8.'Q!A&'!)(!;4.-*;%).<!%&)(!1'('01;&!0(!/01%!43!0!>&=Q!!Who has reviewed the study? A;&442!43!B'02%&C!E-*;0%)4.!0.-!D4,,*.)%8!A%*-)'(C!941%&*,+1)0!6.)7'1()%8Q!9BA!]4;02!?'('01;&!E%&);(!D4,,)%%''(Q!y!B4(/)%02(!9BA!R1*(%!d!?'('01;&!a!='7'24/,'.%!='/01%,'.%Q!!!!Contact for Further Information [(Q!A*'!S4:2'1C!>4(%<10-*0%'!?'('01;&!A%*-'.%!NS*22!%),'!>&Q!=!>14<10,,'O!A;&442!43!B'02%&C!D4,,*.)%8!0.-!E-*;0%)4.!A%*-)'(!!D40;&!]0.'!D0,/*(!E0(%C!941%&*,+1)0!6.)7'1()%8!9':;0(%2'!*/4.!R8.'!9EX!Xy$Q!R'2T!!!Or >143'((41!=07)-!A%0.2'8C!A;&442!43!B'02%&C!D4,,*.)%8!0.-!E-*;0%)4.!A%*-)'(C!941%&*,+1)0!6.)7'1()%8C!0(!0+47'Q!R'2QT!FWGW!"WU!K"KW!

! "GG

A;&442!43!B'02%&C!E-*;0%)4.!0.-!D4,,*.)%8!A%*-)'(C!941%&*,+1)0!6.)7'1()%8C!

B"WH!D40;&!]0.'!D0,/*(!E0(%C!9':;0(%2'!*/4.!R8.'C!

9EX!Xy$! ASSENT FORM

!

Title of Project:!!R&'!142'!43!(4;)02!:41@!).!%&'!&4(/)%02!-)(;&01<'!43!42-'1!/'4/2'!!Name of Researcher: Sue Fowler!!!WQ! I!;4.3)1,!%&0%!I!&07'!1'0-!0.-!*.-'1(%0.-!%&'!).341,0%)4.!(&''%!

-0%'-!QQQQQQQQQQQQQQQQQQQQQQQQQQQQ!341!%&'!0+47'!(%*-8!0.-!&07'!&0-!%&'!4//41%*.)%8!%4!0(@!5*'(%)4.(Q!! ! ! !

!"Q! I!1';4,,'.-!%&0%!%&)(!('17);'!*('1P(!;24('!1'20%)7'\;01'1!;0.!+'!0//140;&'-!%4!

/01%);)/0%'!).!%&'!1'('01;&!&07).<!V*-<'-!%&0%T!o! >01%);)/0%)4.!)(!.4%!0<0).(%!%&'!).%'1'(%(!43!%&'!).-)7)-*02!0.-!!o! R&0%!%&'!).-)7)-*02P(!;01'1\;24('!1'20%)7'!,08!<0).!(4,'!+'.'3)%!314,!

/01%);)/0%)4.Q!!A*;&!+'.'3)%(!;4*2-!).;2*-'!/01%);)/0%).<!).!0!;4220+410%)7'!'.7)14.,'.%!0.-!&07).<!%&'!4//41%*.)%8!%4!'L/1'((!%&')1!7)':(!%4!0.!).-'/'.-'.%!1'('01;&'1Q!!!

#Q! !I!@.4:!%&0%!/01%);)/0%)4.!43!%&)(!;24('!1'20%)7'\;01'1!)(!742*.%018!0.-!%&0%!%&)(!

/'1(4.!,08!-';)-'!.4%!%4!/01%);)/0%'!41!,08!-';)-'!%4!/01%);)/0%'!+*%!;0.!:)%&-10:!0%!0.8!%),'!!

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Appendix 11 - Comments from a voluntary organisation !

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References !

$22'.Q!IC!B4<<C!=!0.-!>'0;'C!AQ!NWGG"O!Elderly people: choice, participation and

satisfaction. ]4.-4.C!>42);8!A%*-)'(!I.(%)%*%'Q!

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$1.(%').C!AQ?C!NWGKGO!c$!]0--'1!43!D)%)l'.!>01%);)/0%)4.PC Journal of the American

Planning Association,!#U!NHO!//!"WKJ"#H!

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research to support the NSFOP!]4.-4.C!=B!

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;0('!'L0,/2'!).!4.'!^1)%)(&!%'0;&).<!&4(/)%02nC!Journal of Advanced Nursing,!#G!NUOC!

//Q!HUFJHUZQ!

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f44-&'0-!S0*2@.'1Q!

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^02-4;@C!g!0.-!6.<'1(4.C!D!NWGGHO!Becoming consumers of community care:

households within the mixed economy of welfare. w41@C!g4('/&!?4:.%1''!

S4*.-0%)4.!ig?SjQ!

!

^02-:).C![Q!N"FFFO!Social work discretion and the construction of policyQ!$2-'1(&4%T!

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