Koppel, Ivan; (2003) Autonomy eroded? : changing discourses in the education of health and community care. Doctoral thesis , Institute of Education, University of London.

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Abstract

The last decade of the 20th century saw unprecedented changes in the organisation of health and community care services in the UK. A substantial change occurred in the roles and functions of professionals. Continuing professional education CCPE) became more pivotal and within that interprofessional education (IPE) gained prominence, on the assumption that it promoted interprofessional collaboration. The crucial elements in this process were the changes in the distribution of power between the stakeholder groups in professional education and the associated shifts in the discourses. The most noticeable background change has been in the transfer of power in the running of the welfare state from the professional to the management group. This thesis argues that this has led to much closer control by management of professional behaviour. The control is actualised through increased emphasis on teamwork, a tighter governance of CPE and the promotion of IPE. Guidance for professional development comes no longer from within the individual concerned but is superimposed from above. Yesterday's takers of initiatives have, perforce, become today's followers of orders. It is further maintained that alongside the changes in power distribution there has been a shift in balance between the prevalent discourses. A rhetoric of co-operation exists between the key stakeholders - managers, educators and professionals - yet each group holds its own construction of the professional and consequently the education that is requisite. Thus, managers want professionals capable of providing an efficient service, educators wish to promote adult learners capable of change, and professionals themselves wish to promote their independence and selfgovernance. Professionals are insufficiently aware of these differences in perspective. They need to be alert to threats to their autonomy in the face of the managerial 'efficiency ethos' - since losing autonomy is arguably neither in their interests nor those of their clients.

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