The review highlights areas of consensus and differences in perceptions amongst interviewees. Changes in view over the last year are included. Reference is made to related issues from within the Literature Review (L.R.) in the context of specific responses. Answers are arranged as in the interview schedule dealing exclusively with questions one through to ten. (See Appendix One).
Question One Answers
The first 'course feasibility' meeting between the Project Leaders (P.Ls) was held in
June 1993. In depth planning commenced in August 1994. Both Course Tutors
(C.Ts) cited their initial involvement began in early 1994, with close links developing
from December that year.
Question Two Answers
Both P.Ls emphasised their negotiating function was crucial to establishing the
political/administrative framework within which the course was constructed. Social
Service structures, in particular, required a wide breadth of consultation before joint
professional ground rules could be established. Presumably, this mirrored the nature
of involvement at national level, regarding the workings of C.C.E.T.S.W. and S.S.I.
The role as facilitators of their respective staff's involvement was also noted.
The secondary planning role of C.Ts was evident. These focused on specific aspects
of course design joint recruitment policies, conducting candidate interviews and from
the Social Work C.T. providing clinical insights into joint professional skills required.
Question Three Answers
All shared a view of course sponsors as Advocates, supporting its rationale at different
levels of their organisations. Both P.Ls. emphasised behind the scenes political
lobbying of some sponsors as being crucial for course validation to succeed. This
perspective links to the D.o.H. (1993) inspired debate on the future direction of RN
(L/D) role noted in the L.R.
Purchasers of student training places were highlighted by everyone as key sponsors.
These included N.W.R.H.A. and Calderstones N.H.S. Trust. However, a wider
perspective, inclusive of L/D Nursing Commissioning agencies (Nurse P.L.) and Social
Service placement providers (Social Work P.L.) were included.
Question Four Answers
Agreement was shared by all regarding purposes of the course. The creation of a
Hybrid Worker encompassing L.D. Nursing and generic Social Worker skills was
emphasised. The Nursing duo envisaged the course would ensure nursing skills were
preserved within L.D. services. Two felt qualifiers would serve as prime managerial
catalysts, as one noted improving 'the handling of the interface between Nursing and
Social Services'. Both C.Ts. viewed the multi-skilled course 'product' as a valuable
cost-effective human resource within C.L.D.T.s.
C.T.s considered S.L. should become the route for nurses to receive their training with
L.D. clients. The social work C.T. felt strongly that 'the rationale for retaining different
pathways has not been thought through'. She queried whether 'there is a continuing
demand for singly qualified RN (L/D)s'. Conversely P.Ls. felt that the S.L. route would
always be only one of a number of flexible approaches to attaining the RN (L.D.)
qualification. Such differences in viewpoint highlight the ongoing debate regarding the
future direction of L.D. Nursing and accompanying role expectations noted in the L.R.
Question Five Answers
All considered there was a strong consensus amongst all course sponsors in favour
of the Hybrid Worker concept. The actual skills required were only vaguely considered
by the sponsors.
Everybody accepted sponsors necessarily had their own agendas to promote within
the course. Three people noted Calderstones Trust's focus was the recruitment of
staff. P.Ls. disagreed over whether 'new blood' would supplement (Social Work View)
or replace (Nurse View) existing staff in community based services being developed
shortly. Three interviewees acknowledged the nursing organisations concern with
preserving L.D. nursing skills within the course.
Several observations were made by two people. The P.Ls. had developed an
excellent working relationship. Practical sponsor commitments being honoured
included course policy statements incorporating the principle of shared professional
ownership, an atmosphere of open debate within planning meetings and necessary
funding being forthcoming. The validation document served as a vehicle for clarifying
areas of consensus amongst course sponsors.
Question Six Answers
All agreed that Top Management within sponsoring organisations had the greatest
impact on pre-course development. The nurse duo highlighted the College of Nursing
and N.H.S. Trusts, especially Calderstones as key players showing strong
commitment. The nurse P.L. felt ambivalence operated at this level - some individuals
'helped open some doors, others helped close other doors'.
Significant support from Clinical Managers was universally acknowledged. P.Ls.
considered these exercised a positive impact within practice teams, as course
advocates.
Consensus existed that direct care staff played a relatively small role within actual
course planning. Some resistance/objections to mounting a S/L course were
acknowledged to exist amongst this personnel grade. This related to perceived threats
to their professional security self image as 'Neanderthal Man' cited by one. The issue
of threats to RN (L.D)s professional integrity noted in the L.T. surface again here.
No one indicated any direct role played by service users or their representatives in the
planning process. However, course purposes emphasised promotion of 'client centred'
approaches to care provision. The L.R. referred to trends facilitating service user
participation in service design and management.
Presently three felt continuing involvement of sponsors beyond the Validation event
had been minimal. Practical instances cited included over twenty nurse assessors
being sent by service managers on training sessions considering the needs of S/L
students while on L.D. placements.
Nurse training Commissioners had sanctioned an intake of forty three S/L students for
the course intake commencing in 1997. Early endorsement of this course echoes
circumstances surrounding the 'new wave' of S/L schemes commencing prior to
Kent/Essex schemes being fully evaluated.
Question Seven Answers
All interviewees viewed the Honest Broker's (H.B.) role as an 'Intermediary' 'Neutral
Negotiator' 'without executive authority'. In this context the H.B. was a communicator
facilitator between two professions having inevitably different traditions and distinct
perceptions of common issues.
Everyone agreed that no one formally played the H.B. role during the planning phase.
Suggestions were offered of individuals/organisations that incorporated some elements
of this role. These included a Calderstones Trust nursing executive, the P.Ls.
themselves, the Validating bodies and the N.W.R.H.A. The Social Work P.L.
considered that adopting the groundrule of dual Nursing/Social Work course ownership
helped negate the need for any formal H.B.
All acknowledged the H.B. role had not been vital for getting the course validated.
Factors offered to explain why included the positive working relationships developed
between the care planning team which ensured a flexibility and open mindedness of
approach. Secondly, the course framework required only minimal compromise within
the bureaucratic structure of either organisation. Three respondents felt that a H.B.
role could have assisted a more radical S/L approach being developed. Thus the
course might have avoided replicating known faults within earlier schemes, principally
their lack of 'jointness' as noted in the L.R.
Question Eight Answers
No one was entirely clear about Accountability/Responsibilities issues regarding the
ongoing course management. Presently, the Social Work duo expressed themselves
generally the more content with arrangements.
Areas of joint clarity included Autonomy being maintained by each educational
establishment regarding regulations over issues of student assessment and in-house
bureaucracies. C.Ts. appeared reasonably clear as to their immediate roles. The
nurse P.L. noted negotiations with Social Work colleagues to facilitate more students
being co-opted into the first programme shortly.
Three people voiced concerns about the future role of the course Steering Group. The
Social Work P.L. saw it as 'an engine to get the course going' but now divested of any
executive powers.
The Social Work duo considered the validation document and accompanying planning
meetings as useful sources of written guidelines for course roles - a view not shared
by the Nurse P.L. He felt communication difficulties were created by inconsistencies
within senior management directives i.e. ' the goal posts keep changing'.
Question Nine Answers
Agreement existed regarding perceived associated L.D. service developments. The
Course was consistent with state social policy trends away from Institutional to
Community models of care. It would also facilitate more effective Multi-Disciplinary
Teamwork.
Question Ten Answers
All agreed that the 'Twin-centre' model for delivery of course theory was not ideal, a
'right mish-mash' according to one person. Both nurses felt students inevitably viewed
the first half of the course as being primarily nursing focused, and the second half
primarily Social worker focused.
The wider socialisation of students was recognised as a highly complex matter, far
more than the physical siting of theory elements. Two emphasised the human
environment as crucial, principally the working rapport of C.Ts. and the social
dynamics of the S/L group itself. Indeed changes effected within the planning of the
second intake, commencing February 1996, would further foster this group's social
cohesion.
Three acknowledged that S/L students had to be socialised within two distinct
professional identities. Spending some time within generic student groups assists the
process. Moreover they needed time as a distinct group, not least for mutual support
to cope with a potentially highly stressful programme. One interviewee had assumed
up to the Validation event that the students would receive all the course theory on one
site for the entire course.