Defining the boundaries: the implementation of health and social care policies for adults with learning disabilities

This thesis examines why community care policies for adults with learning disabilities have proved so hard to implement in a sustained, equitable manner, and explores the apparent chasm between official policy and actual practice in the light of current theories of social policy implementation. It focuses specifically on the relationship between health and social services, and investigates the factors which affect the ability of these agencies to co-operate effectively in the provision of services to this client group. The study compares services in two areas of England. In each study area a series of semi-structured interviews were conducted with staff at all levels within statutory learning disability services, from senior health and social service managers to frontline practitioners. Interviews were taped and transcribed in full prior to coding. Analysis was informed by both grounded theory and discourse analytic methodologies, but is best summarised as a thematic content analysis. Findings suggest that three major factors affect inter-agency relations and impact upon policy implementation: the complexity of service structures; professional and cultural differences between health and social service staff; and the wide variation in the local interpretation of national policy. The implications of these findings for the future of learning disability services are discussed. In particular, the need for policy makers and implementers to pay greater attention to the creation of organisational structures which encourage, rather than hinder, cooperation across traditional agency boundaries is emphasised