The enablers

Volunteers who help older peoplereadjust to home life after time
in hospital can play a vital role in boosting confidence and
breaking down isolation. This kind of service is known as
intermediate care.

The government is funding a project managed by Help the Aged to the
tune of £688,000 aimed at integrating voluntary sector
services in intermediate care for older people. It consists of
seven programmes in England:

• The Calderdale intermediate care partnership project hosted by
  Age Concern.
• Healthy Homes in Sefton hosted by Anchor Staying Put.
• Connections in Bournemouth hosted by Help and Care.
• Rustic (Rural Support Team for Intermediate Care) in Essex
  hosted by the Dengie Project Trust.
• Stepps in Sefton hosted by charity Personal Service
  Society.
• Coral (Community Outreach for a Return to Active Life) hosted
  by Help the Aged together with North Surrey Primary Care Trust and
  based in Chertsey.

Feedback from older people suggests they consider that these
intermediate care volunteers help them feel more confident about
living at home, and more independent.

Volunteers have also proved a boon for projects. Lisa Kay,
co-ordinator of the Rustic Project based in Southminster, Essex,
says: “Intermediate care volunteers offer flexibility, less
bureaucracy, a quick response and a good understanding of local
issues and services in our rural area.”

All seven projects have a dedicated worker like Kay who double up
as a volunteer co-ordinator and voluntary sector care manager.
Working with NHS and local authority intermediate care services,
the aim of the projects is to offer care packages to meet
practical, personal and medical needs.

The success of the volunteer recruitment programme has varied from
area to area, says Michelle Cornes, Help the Aged intermediate care
programme manager. In one inner city it has been almost impossible
to recruit volunteers, while in rural Dengie in Essex a team of 15
volunteers was quickly set up. Intermediate care volunteering seems
to appeal most to those who have worked in health or social care.
Those with little experience of this type of work can find
vulnerable clients difficult to cope with and feel daunted by
working alongside professional staff.

Each project has developed different relationships with their NHS
and local authority intermediate care services, says Cornes. She
recognises that there’s a more traditional relationship between the
statutory and voluntary sectors in most sites.

“The voluntary sector projects exist as separate entities,
geared-up to accept referrals from the physically distant
intermediate care teams. Where voluntary sector care managers sit
outside of the intermediate care teams, generating mutual trust and
understanding around integrated practice is proving harder.”

In one area pressure has been placed on the voluntary project to
accept clients who do not meet the criteria of the intermediate
care team. “These cases have required more than just a low level
preventive intervention and volunteers have found themselves
working in isolation with some very complex cases resulting in
readmission of the client to hospital within 24 hours of
discharge,”says Cornes.

Sheila Lakey, assistant director of intermediate care at North
Surrey Primary Care Trust, which is involved with the Coral project
(see box), says: “This is an important step in promoting a less
medical and more holistic, patient-centred view of intermediate
care.”

Betting on coral  

The Coral project, a partnership  between Help the Aged and
North Surrey Primary Care Trust, aims to develop a database and
directory of local voluntary services; co-ordinate requests for
voluntary services and set up support care packages; develop a
strategy for increasing the involvement of older people, and
recruit volunteers to join the intermediate care team. 

Project co-ordinator Lorraine Nelhams is employed by Help the
Aged but is managed on a day-to-day basis by the PCT. Value has
been placed on developing relationships with voluntary service
providers to reassure them that they were not competing for
volunteers and explore possible joint working. Nelhams is now
working with the local intermediate care rapid response team to
match volunteers and voluntary services to older people’s
needs.