Shifting Sands: Contested Boundaries in Adult Social Care

In this thesis I present a narrative that describes and analyses the contested and moving boundaries in adult social care through the lens of three enduring themes: the health and social care interface; hospital discharge and NHS continuing health care; and eligibility for adult social care. The thesis draws upon a range of my published work undertaken from 2002-2011, and this in turn reflects a wider body of work undertaken from the 1980s onwards. The thesis is developed from my work which comes from a distinctive model of independent research and analysis, combining original empirical fieldwork and evaluation with detailed policy analysis and commentary. The publications are principally derived from research studies and evaluations commissioned from me by the Department of Health; by the Commission for Social Care Inspection (CSCI), and by the Putting People First Consortium and the Social Care Institute for Excellence (SCIE).

This thesis examines the problematic boundaries between adult social care (particularly in the care of older people), and the NHS which have been in evidence since the creation of the two systems, and the extent to which these boundaries are contested and fluid over time. I argue that the location of the boundary is of great significance because of the consequences not merely for respective organisational responsibilities and budgets, but also - importantly - for individual service users and their families.

The thesis was written on the cusp of the introduction of major legislation in social care, with the Care Act 2014 due for phased implementation from April 2015. It is an opportune moment to consider how and to what extent the Act offers the prospect of stabilising the shifting sands of the landscape of adult social care.