At the time of the study, community staff were aware of further changes in service such as transformation into care pathways later in the year. Staff opinions might have been influenced by this. However, we employed theoretical sampling and did reach saturation of themes, which should increase transferability of the results.The research team also works in the Trust and was affected by the changes like the participants. In order to minimise observer bias, measures were taken to standardise interviewing techniques and interpretation of statements.
Implications for further researchIt remains to be formally tested whether or not separate hospital and community services provide better psychiatric care than sectorised services.9 Parameters that can be examined at a later stage might include number and frequency of re-admissions, bed occupancy, patient and carer satisfaction, number of critical incidents, satisfaction and stress level of ward and community staff, and recruitment and retention rate of staff.
Concluding remarksDespite various concerns regarding the change, the need for cohesive working and a patient-centred approach regardless of service design was voiced. 'We have seen changes before, I am sure we can make this work, it doesn't really matter what system we work in . . . at the end of the day this is all about team work and caring for patients.' (Senior nurse)
AcknowledgementsWe thank all the staff members who participated in this study. We are also grateful to Dr Jesus Perez, AssociateClinical Director and Consultant Psychiatrist, and to Maggie Evans, Academic Unit of Primary Health Care, University of Bristol, for their valuable comments on the manuscript.
Declaration of interestNone.References