Beliefs, culture and circumstance : a critical examination of the concept of professional ideology in relation to the health and social services
The research described in this thesis is concerned with examining the views of a range of health and social service professionals towards policies devised by central government in the mid-1970s, relating to the care of particular patient or client groups, namely, elderly, mentally ill. and mentally and physically handicapped people. The policies called for priority in resource allocation to be given to these groups - although this was likely to involve withdrawing resources away from other groups (notably from the acute sector within the health service); they also called for a move away from institutional care towards community care. By the beginning of the 1980s. little progress in achieving such a shift had been made. and recent reports in the late 1980s suggest that subsequent progress has also been slow. Analysts have given various reasons for this failure, but this study is founded on the proposition that professionals in the organisations responsible for the delivery of care to the 'priority' or 'dependency' groups are likely to have played a significant role in the only partial implementation of the policies. It reviews literature on theories of social policy development. organisational behaviour and the role and significance of professionals in organisations, arguing that the beliefs and attitudes of professionals may amount to what can be called ideologies which condition and mould behaviour. The study is based on extended, semi-structured interviews with 236 respondents in three Scottish locations. It finds that distinctive patternings of attitudes emerge according to professional affiliation; other factors, however, also exert a conditioning effect - such as organisational position, agency membership and the practitioner/manager distinction. Attitudes directly relating to the policies themselves are moulded by the significance which the issues hold for the respondents concerned - thus a dichotomy between the abstract and the concrete emerges. Although support for the policies in principle is usually forthcoming, it tends to be couched in equivocal terms. The study concludes that such ambivalent attitudes are likely to play a major part in shaping the outcomes of the policy process.