The Knowledge

Influences on Multiple
Sclerosis Respite Care

Knowledge Work in Healthcare Practice

(Student Number 086415323)
Module: 3OP050

Word Count: 5472

Faculty of Health & Life Science

Module tutor: Julie Dickinson

(First Attempt)

Page 1 of 20
The knowledge influences on Multiple Sclerosis Respite Care have been thoroughly
considered throughout this assignment, with a view to cast some informed light on a subject
area that has seemingly been, in the main, overlooked. From the outset, philosophy and
construction of knowledge will be explored, considering historical views and concepts of
knowledge. These views will be considered through the use of contemporary sources of
evidence and critiqued. Information from Devitt-Jones (2007) will be used to inform upon the
concept of ideology in relation to knowledge production and shown to be likened to accepted
knowledge frameworks surrounding more established sciences.

The social construction of knowledge will be discussed in depth, considering political

influences and how those and different perceptions of socially constructed knowledge
influence MS and respite care. Two personal ideological views will be considered when
looking at the use of respite care, and how opinions like these may have influenced the
potential closure of four MS respite centres across the United Kingdom. Political ideology
and influences will be discussed, highlighting fundamental knowledge structures; for
example: the National Service Framework for long term conditions (Department of Health,
2005), also considering the political influences, if any, on those said frameworks of
organisational knowledge within the healthcare system.

Blackler (1995) will be used to highlight ‘types’ of knowledge used within contemporary
society and examples will be given showing their relation to MS and respite care. Following
on, more key knowledge frameworks will be discussed in depth, considering drivers of
knowledge within the current healthcare system (MS and respite care) and how, in turn,
these drivers influence patient outcomes. The concept of respite will be defined, looking at
how services were viewed from a historical perspective in the 17th century and how they
devolved into the 20th century (Deutsch, 1949).

The development of the expert patient agenda will be considered in line with the introduction
of the National Health Service and a nursing perspective from the 1950’s (Eldridge et al,
2007). Intuitive expertise will be explored discussing the notions of tacit, implicit and explicit
knowledge, showing how these knowledge concepts underpin collaborative working
between expert patient and healthcare professionals (Eldridge et al, 2007). Several
knowledge drivers will be shown to influences the healthcare system, paying particular
attention to economic drivers; Griffin (2007) will show how these drivers have affected gross
domestic expenditure and, in turn, how the government has pledge to address this situation
(House of Commons Trade and Industry Committee’s, 2005). Finally, the transition from the
manufacturing economy to what Devitt-Jones (2007) describes as the knowledge economy
will be considered, followed by the assignments conclusion, however, the reader will now
begin with philosophy and construction of knowledge.

Page 2 of 20
Knowledge or the nature of knowledge was once understood and famously dialogued in
Plato’s Theaetetus 347.B.C as, “knowledge being a true belief that has been given an
account of” (Barnes and Burnyeat, 1980: p173). Silverman (2008) recognises, around
Plato’s middle period, philosophy was split into three main areas; these were Epistemology,
Ethics and Metaphysics. When looking at the latter two areas it can be seen that, Ethics
(how one considers right and wrong, happiness and pleasure), Metaphysics (physical
entities of the world and why it’s there) both require thought, a level of understanding and
knowledge which seemingly blend without real autonomy into Epistemology (Silverman,
2008).

Epistemology is by definition the study of knowledge, this study can be broken down into
many subjective categories, for example: What are its origins? What variables are needed to
substantiate knowledge? And what constitutes the framework and boundaries of
knowledge? (Steup, 2005). Using the descriptions noted above the reader could try and
quantify their own personal philosophy of knowledge and further consider how you know
your knowledge justification is justified. Looking at epistemology in a more objective manner,
it can be acknowledged as how information is created and in turn how that information is
conveyed in certain areas and within society (Steup, 2005).

Devitt-Jones (2007) suggests that areas such as problem solving, considering right and
wrong, debating moral view points (happiness and pleasure) and philosophy based around
understanding physical entities of the world are all ways which could constitute critical
thinking. The exact origins of knowledge philosophy, critical thinking and knowledge
production are debatable; some believe its development lies with the ancient Greeks,
whereas others debate critical thinking and knowledge production is a model of thinking
more akin with modern society (Devitt-Jones, 2007).

Devitt-Jones (2007) considers the concept of ideology as being a multifaceted arena in

which the quest for knowledge production and acquisition occurs. Concepts of ideology have
changed through time, its recognition was first noted by Antoine Destutt de Tracy in 1796,
likening ideology as a science of ideas and further contrasted the science of ideology to
other more established sciences such as physics and biology (Devitt-Jones, 2007). Given
the established boundaries of physics and biology it was thought that ideology could be
accepted in the same context as other more established sciences, enabling society to form a
bounded framework of ideas and understanding (Heywood 1998).

Heywood (1998) alludes that contemporary construction of societal knowledge has been
linked to the overarching framework of ideology; Heywood (1998) believes that ideology is
responsible for societies understanding of the world, helping people to set and achieve
goals, shaping their wants and/or needs, also incorporating political structure and control.

Page 3 of 20
So when looking at the development of knowledge and knowledge production there is a
clear intrinsic link to ideology (science of ideas) and how contemporary society has become
a population of thinkers.

Although Heywood (1998) notes, that historically critical thinking, knowledge production and
ideological frameworks are often viewed in a pejorative manner and opinions often differ.
Marx (1846) and Marxists alike looked at ideology in a completely different way, associating
ideology to false consciousness (belief that people are not aware of their oppression and
their inability to comprehend detrimental situations) and manipulated thought. Although
Heywoods (1998) and Marx (1846) ideological standpoints are different in opinion, there is
clear cohesion between ideology and the social construction of knowledge within society,
whether it is noted positively or with negative connotations.

Social construction of knowledge and sociological theories has been seen to consider how
experience, phenomena and or objects are concepts of consciousness that occur or change
within a societal context (Goldblatt, 2004). When something is socially constructed the
concept linked with personal ideology evolves within or from a constructionist group or
thought, its dependence is based on subjective variables of one’s self as opposed to its
inherent existence (Goldblatt, 2004). For example: Multiple Sclerosis (MS) respite care is a
concept that does not tangibly exist (in real time in the real world), although through social
groups (those with MS) institutions (MS Society) involved with MS, understanding, meaning
and belief has been given, thus creating the cultural belief that respite care is an important
factor when providing a care package (Multiple Sclerosis Society, 2010b). Although recent
evidence outlined in the respite care review has shown that personal ideology and subjective
variables have played a substantial role in reshaping the landscape of MS respite care within
the United Kingdom (Multiple Sclerosis Society, 2010c).

Subjective experiences of two people with MS have been shown below; they consider the
closure of respite facilities and display opposite ideological views.

The Independent (2010)

Person 1: Female aged 64, diagnosed with MS in 1985. “I used the MS respite centres once
15 years ago and it wasn't very pleasant. I found they took away my independence”

Person 2: Female aged 58, diagnosed with MS in 1988. “I was nervous it would mean sitting
staring out the window, but it was not like that. It is like a health spa. After my first time, my
family said I looked 10 years younger” (The Independent, 2010: p1).

In June 2010 the MS Society decided on a new way forward when considering how to
facilitate the needs of those with MS, this decision was made after a yearlong review

Page 4 of 20
considering the needs and aspirations (ideologies and beliefs) of those with MS (Multiple
Sclerosis Society, 2010A). This move towards a more client centred approach can be viewed
in line with the National Service Frame (NSF) document for long term conditions
(Department of Health, 2005). The NSF document is a 10 year commitment set by the
previous Labour government, the framework remains the same but is ‘said’ to have been
built on by the new coalition Government, in which they will “accelerate the pace of
improvement through a greater focus on local delivery and accountability and ensuring that
citizens are empowered to hold local organisations to account” (HM Government, 2010: p1).

Although political ideologies have changed, one can see the aims and objectives within the
Department of Health (DOH), NSF and NHS have remained fundamentally the same (when
considering a client centred approach to MS treatment and respite care) (HM Government,
2010). One reason for consistency within the surrounding knowledge frameworks could be
due to evidence based practice (research related to MS) and evidence based resources, for
example: decisions related to treatments such as respite care (Evidence-Based
Occupational Therapy, 2009). When conducting research into MS and health related quality
of life evidence-based practice (EBP) provides an integrated approach, taking into account
the clinician’s expertise and the persons with MS background, preferences and needs
(Evidence-Based Occupational Therapy, 2009). Similarly evidence based resources such as
NHS evidence provides comprehensive information for people who work in health and social
care (who make decision about respite care and other treatments for MS), this information
source normally provides high quality research which is often systematically reviewed (NHS
Evidence, 2010). The British Medical Journal (2010) acknowledges EBP as best practice
supporting a point of care approach, providing awareness and access to current information
based on clinical consultation and practice. These information sources are clearly used to
inform on practices and professional understanding, therefore existing healthcare knowledge
frameworks may not be subject to political ideology.

With that in mind, the vast majority of evidence used within this assignment is organisational
frameworks, which have established embedded practices and governances, and as such,
this information is available through the internet, for example: published policy documents
and green papers (knowledge Technology). This sort of information has gone through a
process of Enbrained, Embodied, Encultured, Embedded and sometimes Encoded
knowledge (Blackler, 1995), all of which will be discussed next.

Having discussed philosophy, ideology and social construction of knowledge and taken
account of the MS societies and Governments collaborative organisational approach, there
are clear concepts of knowledge emerging. These concepts were refined by Blackler (1995)
through the consideration of cognitive images within organizations in the attempt to give the

Page 5 of 20
characteristics of organizational knowledge a cognitive dimension, five knowledge ‘types’
were detailed and are said to be useable within any organisation.

1. Embrained knowledge: Ability to conceptualise using academic know how. This could
be shown as the research carried out by the MS society to establish the need for respite
throughout the United Kingdom (Multiple Sclerosis Society, 2010c). Having conducted a
nationwide survey and through focus groups (academic know how) researchers found
that people with MS wanted more personalised services when accessing their respite
care (Multiple Sclerosis Society, 2010c). Having conducted the research a concept of
preferred access was apparent, 65% of participants were noted as saying they wanted
respite care within a modern holiday venue assisted by a carer and a further 14%
without a carer (Multiple Sclerosis Society, 2010c).

2. Embodied knowledge: most typically gained through social interaction and actions of the
individual influenced by their surroundings (Blackler, 1995), for example: the exercise
routines care staff show people with MS to maintain muscle tone (Multiple Sclerosis
Society, 2010c). This is non-explicit knowledge and by virtue is not easy to verbally
explain; therefore visual demonstrations help to give understanding (Blackler, 1995).

3. Encultured knowledge: shared knowledge and understanding gained through from

groups or individuals often from different cultures, or when looking specifically at
healthcare, different teams or peopled involved within the process MS respite care
(Blackler, 1995). This type of environment may provide clinicians, carers and persons
with MS the basis on which knowledge can be developed and or negotiated, in turn
building on their own understanding.

4. Embedded knowledge: Out of the 5 concepts of knowledge types Blackler has noted,
embedded knowledge is perceivably the most influential, it takes an over arching view
when considering organisational concepts involved (Blackler, 1995). Embedded
knowledge is articulated, documented and contained within many media sources all of
which form protocol, routines and governing procedures (Blackler, 1995). One could say
this type of knowledge forms the backbone of any organisation, for example: the NSF,
DOH and the National Institute for Clinical Excellence, all of which are critical knowledge
frameworks surrounding MS and respite care for long term conditions (Department of
Health, 2005). These knowledge frameworks will be discussed shortly.

5. Encoded knowledge: This type of knowledge and/or information could be loosely

categorised as religion, foreign languages, signs and symbols, in other words,
information that has been decontextualized into codes or procedures (Blackler, 1995).

Page 6 of 20
Core knowledge typifying all of Blackler’s knowledge ‘types’ are reflected in one shape or
form when looking at the key healthcare knowledge frameworks, these frameworks surround
MS and respite care in today’s current society and, as mentioned previously, have been
passed from Tony Blair’s Labour Government to the new Coalition Government (HM
Government, 2010).

To recap, Department of Health (2005) has identified several key knowledge frameworks,
NSF (working with DOH and governments vision on providing targeted treatment, funding
and patient centeredness at a local level), DOH (government department linked to NSF and
NHS to provide improvement in quality of life), Long Term Neurological Conditions (LTNC)
(part of DOH geared towards 11 Quality Requirements (QR’s), again local implementation
and patient centred) and MSS (charitable organisation providing respite care at four
locations through the UK and leading information source on MS)( Multiple Sclerosis Society,
2010c). There are several avenues in which further discussion could focus, although when
reviewing the evidence related to MS and Respite Care two interrelated themes were
apparent within all: namely the 11 QR’s and a patient centred driven service. These QR’s
could be seen as one of the many improvements within the MS and respite arena and as
such could be considered to be a major driver within this context.

The Department of Health (2010) indentifies the NSF as fundamental in supporting those
with MS. This is also reflected in the National Health Service (NHS) Improvement Plan:
Putting People at the Heart of Public Services (Department of Health, 2004). At the centre of
this framework are major drivers within MS and Respite Care, such as eleven QR’s, detailing
models of practice for different clinicians involved with neurosciences, initiatives detailing
local implementation and guidance for future practices (Department of Health, 2005). There
are 11 QR’s relating to long term conditions, MS and Respite Care, however only 2 QR’s will
be discussed, specifically concentrating on knowledge surrounding respite care and person-
centred service (Department of Health, 2010).

Department of Health (2010) QR 10 - Supporting Family and carers is a vital intervention for
those with MS and for the majority involved, caring is unpaid. Although supporting the carers
are knowledge frameworks which provide protection and governance during their services,
for example: Carers Recognition and Services Act 1995, the Carers and Disabled Children
Act 2000 and the Carers (Equal Opportunities) Act 2004 (Department of Health (2010).
These frameworks of embedded knowledge provide protection and governance to all parties
involved; particularly those with MS and Respite Care staff (Department of Health, 2010).
Staff within respite care centres often need training (Embrained or Encultured knowledge)
which provide skills when, for example, moving or feeding a person with MS (helping with
daily activities) or assisting staff to understand the cognitive behavioural issues such as
anger or depression (Department of Health (2010).

Page 7 of 20
The main aim of QR 10 when providing respite care is to recognise the needs of those with
MS and, more so, fundamentally the needs of the carers in their role and in their own right
as a person (Department of Health, 2010).

Multiple Sclerosis Society (2010A) acknowledge the DOH’s QR approach when considering
MS and respite care, noting that care surrounding MS is based on personalisation, putting
people first and supporting independent living. The Multiple Sclerosis Society (2010 A) states
that the purpose of respite care is to “provide a break which is a positive experience for the
person with care needs and the carer where there is one” (Multiple Sclerosis Society, 2010A:
p.5). Furthermore the Multiple Sclerosis Society have seen a change since the 1980’s,
acknowledging that their services were initially intended for those at local community level
however, over the years, these services seem to have attracted a more cohort strategy
(Multiple Sclerosis Society, 2010A). This change over the past 30 years is a direct reflection
of the expectations of those with MS and how services may be disseminated in the future
Multiple Sclerosis Society (2010A).

Expectations and the understanding of those looking at MS or respite care and how services
have (historically) and will be commissioned in the future are personal views, based on the
social construction of knowledge (Goldblatt, 2004). For example, in the 17 th century MS was
unknown and could have been mistaken for a mental illness, as such neither societal
knowledge nor material conditions made it possible to establish a system of respite care
(Deutsch, 1949). Society’s opinions on where patient care should come from have been
historically tainted with a series of acute changes in social philosophy (Hatfield and Lefley,
2003), for example: originally family were the central ‘framework’ of care, relying on
knowledge passed through each generation, which meant the community bore little social
responsibility (Hatfield and Lefley, 2003). Heading into the early 19th and 20th century, care
progressed from being family/home orientated to becoming institutionalised (Hatfield and
Lefley, 2003). Then, once again, another change of social philosophy in the 1950’s saw
family and community as the ‘framework’ for patient care (Hatfield and Lefley, 2003).

Hatfield and Lefley (2003) describe conditions (without healthcare frameworks and respite
care) in the 17th century, as families being “on their own without the mitigating effects of
medication, physicians or support services” (Hatfield and Lefley, 2003: p4). Therefore it
would be logical to assume there were complex mental and economical hardships bestowed
on families historically and that it would be easy to judge past ‘frameworks’ (existent or none
existent) from a 20th century perspective.

Page 8 of 20
Conversely today there is a well established framework, the Department of Health (2010)
QR 1 - A person-centered service, which shows how the modern day patient is fortunate in
having quality standards of support with an emphasis on improving the patient’s experience.

Person centred management of long-term health conditions such as MS is reflected by the

current National Service Framework and has been documented by the Department of Health
in a current research study (Department of Health, 2009). The impetus behind the paper was
to assert a ‘person centred’ approach; this was done by reviewing the general well being of
people with LTNC and the healthcare services itself and by reviewing self care advice
(Department of Health, 2009).

One of the programs aimed specifically at LTNC was the expert patient program, the
programme is based on greater patient involvement, more informed decision making and
through technology and media sources an increase in information (Department of Health,
2009). Through the increase in provisions, such as, information, training courses and
professional sources of information (DOH, NSF, LTNC knowledge frameworks) accessible
via the internet, a high percentage of patients are realising they are not alone (Department of
Health, 2009). This has been statistically reflected within the research, noting that since 2005
there has been a significant increase in the awareness of information and resources
available (Department of Health, 2009).

This increase and greater awareness (access to professional information and lived
experience) has produced, what is known today as, the expert patient, the likes of which
were unheard of in the 1950’s (Eldridge et al, 2007). Doctors, clinicians, and other healthcare
professionals acknowledge that patients with chronic conditions such as MS often relate and
subsequently understand their disease better than the professionals (Eldridge et al, 2007).
Benner (2002) believes that (nurses, physiotherapist, healthcare professionals’ etc.) work
best as reflective practitioners, intuitively drawing from their experiences, taking that practical
experience and combining it with their knowledge and embedded expertise.

When considering the two views above, one can see that there are similarities between the
two, both expressing concepts of personal experience grounded in theoretical knowledge.
Collins (2010) believes that these types of knowledge are better described as tacit
(knowledge know only by oneself that is difficult to communicate) and explicit (this is stored
knowledge that can be easily communicated). Notions of intuitive expertise have been
explored by Eraut (2003) pointing out how tacit knowledge can be made explicit (those with
MS whilst in respite care sharing their experiences with healthcare professionals), thus in
turn giving implicit knowledge (knowing how). Tacit, explicit and implicit knowledge underpins
the concept of the expert patient and their interactions with healthcare professionals, in turn

Page 9 of 20
offering an attractive option for the healthcare planners by consuming fewer healthcare
resources and offering cost savings (Eldridge et al, 2007).

Access to information has not always been so readily available and since the start of the
NHS on 5th July 1948 there has been a significant shift in technology (internet and media),
education, organisational structure and accountability (Nursing Times, 2008). In the 1950’s
the healthcare profession was seen as authoritarian, where matrons ruled the roost,
receiving the upmost respect from doctors, nurses and patients alike (Nursing Times, 2008).
This could have been attributed to the privileging of knowledge. Unlike today, nurses in the
1950’s were not degree qualified and learnt their job as they went along, which meant unless
you were time served, knowledge may have been limited thus restricted or privileging
knowledge and creating a authoritarian environment (Nursing Times, 2008). Conversely a
modern day nurse (degree educated with access to university and advance professional
databases/internet) would have been likened to a doctor of the 1950’s (Nursing Times,
2008). Due to the infancy of the NHS in the 1950’s there was noted as being a “bedding-in
period” of 10 years, this is where both staff and the NHS as an organisation began to
establish itself (Nursing Times, 2008). Privileging of knowledge will be discussed in more
detail towards the end of this assignment; however the progression of knowledge within the
NHS and its drivers relating to MS and respite care will now be considered.

Batalden and Davidoff (2007) identifies the structure of charitable, government and private
organisations as fundamental to progression within the current NHS healthcare system,
noting that there are five major knowledge drivers which need to be further understood.
These also support previous discussions, namely, generalised evidence base (empirical
studies of MS and Respite Care), contextual awareness (social and cultural knowledge,
understanding of local setting and traditions), QR’s surrounding MS (performance
measurements and quality regulation using knowledge types such as Blackler’s) (Blackler,
1995), governance and planning (linking existing frameworks and knowledge basis,
providing connecting contextual evidence) and monitoring of plans (providing insights into
the reality of existing frameworks and highlighting week and strong drivers) (Batalden and
Davidoff, 2007). The five areas mentioned within Batalden and Davidoff (2007) knowledge
systems for improvement are evident within the current key frameworks surrounding MS and
Respite Care, although having reviewed existing evidence, empirical studies surrounding MS
Respite Care are limited at this point in time.

The previous considerations surrounding healthcare drivers are shared by House of

Commons Trade and Industry Committee (2005), when conceptualising a knowledge driven
economy. House of Commons Trade and Industry Committee (2005) discussions were had
with several stake holders within the DOH, where quality and practice based research

Page 10 of 20
ranked highly when considering the future assessment of multidisciplinary and
interdisciplinary research (empirical studies). This area was noted earlier by Batalden and
Davidoff (2007) as the fundamental area on which to base the progression needed within
MS and Respite Care. Viewing the DOH, NSF and Houses of Commons proposals side by
side and critically appraising them, one can see there are clear interlinked aims and
objectives. For example, the Government/DOH have implemented the 10 year plan for long
term conditions providing “improvement through a greater focus on local delivery and
accountability” (HM Government, 2010: p1), and the House of Commons Trade and Industry
Committee (2005) have also stated long term objective to be reviewed in 2014, this was to
increase gross domestic expenditure (GDP). Based on the fact that the DOH, NSF and the
NHS require funding, one can see that the DOH’s 10 year plan when considering long term
health conditions, MS and respite care is a derivative of the House of Commons Trade and
Industry Committee’s (2005) objective to increase GDP.

Griffin (2007) from the Office of Health Economics identifies that, as a percentage, the UK’s
GDP increased by 7.1% from 2001–2006, surpassing that of several other European
countries. Conversely, when looking at the knowledge economy on a global scale one can
see that the UK has entered into the deepest recession since the Second World War, which
subsequently means a reduction in public spending of £30 billion per year (HM Treasury,
2010). The forecasted reduction in public spending by the new coalition government could
be seen as politically motivated, with their focus more on re-election then reducing the
national deficit.

Daniel Hannan, himself a Conservative MEP, commented pre election saying “Does anyone
imagine that either Brown or Cleggie would join a coalition ministry dedicated to bringing the
over spend back under control? In any coalition, would be to position themselves for an early
dissolution by ensuring that they were not associated with unpopular measures” (The
Telegraph, 2010). Understanding the other half of the coalition Government are
Conservatives. One may draw the same conclusion; nobody running for Government wants
to seem unpopular and has re-election firmly in mind.

This would clearly indicate politics and economy as two major knowledge drivers within the
UK’s current healthcare system and one that could link knowledge to the potential closure of
four MS Respite Centres across the UK.

However, when considering one of the most influential knowledge drivers within healthcare,
MS and respite care, one should consider the transition from the ‘past’ manufacturing
economy to that of the ‘current’ neo-capitalist knowledge economy (Devitt-Jones, 2007).

Discussions earlier were based around Nursing Times (2008) NHS of the 1950’s, showing
how a lack of knowledge (learning as you went) and little organisational structure (infancy of

Page 11 of 20
the NHS) privileged knowledge to those of senior positions leading to an authoritarian
hierarchy. Marx (1846) considers this process (authoritarian control) as ‘smoke and mirrors’,
which deludes and mystifies, giving those with material output (as the result of knowledge
production) overall economic and social control. Therefore based on Marx (1846) notion of
the onerous mental production and thinkers being fundamental to the socio economic
process, one could contrast this with the past 1950’s NHS (respite care) and attribute current
progression to advances in technology, greater infrastructure (NSF, DOH, and LTNC etc.)
and more highly educated work force.

Devitt-Jones, (2007) echo’s the views of Marx (1846) when considering knowledge as the
main component which allows the development of critical thinking, based on the thinker’s
ideological boundaries. However, Curry (1997) questions whether the worker possessing the
knowledge is key to organisational progression and wealth creation, noting that the concept
of owning knowledge is too simplistic. Furthermore, Curry (1997) compounds his ideology by
suggesting unless manual labour is no longer required and has no value to the economy
then knowledge and information are not autonomous determinants of value, and as such its
very notion is flawed. One things is for sure, the explosion of information technology in the
1970’s increased the shift from a manufacturing economy (producing material outputs) to a
more knowledge driven economy, producing intellectual capital organisations, for example:
Microsoft, Apple, and Research in Motion) (Powell and Snellman, 2004).

The Organisation for Economic Co-operation and Development (OECD) (1996) states, “The
growing codification of knowledge and its transmission through communications and
computer networks has led to the emerging ‘information society’. The need for workers to
acquire a range of skills and to adapt these skills underlies the ‘learning economy’ (OECD,
1996: p1).

Considering the views and opinions discussed and relating them back to MS, respite care
and the patient centred care for long term conditions, the expert patient agenda typifies the
contemporary shift towards a knowledge economy (Department of Health, 2001).
Collaborative knowledge production has proven to be valuable, bringing together the person
with MS, the clinician and NHS as a whole in developing a system, which provides the
patient with control over their own life (Department of Health, 2001).

In conclusion, having considered knowledge and how its construction has affected MS
respite care, one could say the shift in how respite is seen and accessed has come about
through the social construction of knowledge. Consciously or un-consciously through
changing societal experience, the context in which respite is now seen has shown to be a far
cry from yesteryear. Evidence has shown throughout this assignment perceptions of respite

Page 12 of 20
care were not always based on objectivity, moreover, the subjective experience of those
accessing MS respite care shaped their own belief and similarly played a substantial role in
shaping the landscape for respite care as a whole.

Closure of the four respite care facilities mentioned within this assignment could have come
about for a number of reasons. It may well have been based on the reviews carried out by
the MS Society (Multiple Sclerosis Society, 2010A), considering how to facilitate the user’s
needs, it could have been in line with the NSF’s greater focus on client centeredness
(Department of Health, 2005b), or, from a political perspective, the current coalition
government may have wanted greater focus on local delivery and accountability, which
ideologically has a conservative slant to it (HM Government, 2010). Looking at the evidence
one thing is quite clear; each organisation is seemingly reading from the same sheet, as
such, there seems to be cohesiveness in the overall progression of respite care within the
United Kingdom.

The main piece of information to come out of this assignment, is that evidence based
practice is fundamental in facilitating understanding and awareness. Not only in a supporting
and caring role for those accessing respite care, but in order to build on existing knowledge
frameworks, in an effort to provide greater clinical intervention.

To conclude, the United Kingdom is a comparatively small country which has previously
enjoyed prosperous times, however, with an ever expanding population, complex social and
political systems at a global level the NHS is clearly trying to keep its head above water.
With this in mind one could suggest that personal needs, knowledge systems and societal
expectation will only become more complex in a bid to maintain economic sustainability.

Page 13 of 20
Bibliography

Batalden, P, B and Davidoff, F. (2007) What is “quality improvement” and how can it
transform healthcare? Quality and Safety in Care, 16 (1): 2-3.

Baumgartner, L. Caffarella, R, S. Merriam, S, B (2007) Learning in Adulthood: a

Comprehensive Guide, 3RD Ed. San Francisco: Jossey-Bass.

Benner, P, E. (2001) From Novice to Expert: Excellence and Power in Clinical Nursing
Practice. California: Courier Westford.

Blackler, F. (1995) Knowledge Work and Organisations: an Overview and Interpretation.

Organisation Studies, 16 (6): 1021 – 1046.

British Medical Journal (2010) BMJ Evidence Centre [Internet]. Available from:
<http://group.bmj.com/products/evidence-centre/who-we-are/for-hospitals-and-clinics>
(Accessed: 24th November 2010).

Collins, H. (2010) Tacit and Explicit Knowledge. Chicago: University Of Chicago Press.

Curry, J. (1997) the dialectic of knowledge-in-production: Value creation in late capitalism

and the rise of knowledge-centred production. Electronic Journal of Sociology, 2 (3)
[Internet]. Available from: <http://www.sociology.org/content/vol002.003/curry.html>
(Accessed: 28th November 2010).

Deutsch, A. (1949). The mentally ill in America: A history of their care and treatment
from colonial times. 2nd Ed. New York: Columbia University Press.

Department of Health (2010) National Service Framework: Going Forward [Internet].

<http://www.ltc-community.org.uk/thensf.asp?id=4600> (Accessed: 21st November 2010).

Department of Health (2009) Long term health conditions 2009: research study
conducted for the Department of Health [Internet]. Available from:
<http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuida
nce/DH_101090> (Accessed: 27th November 2010).

Page 14 of 20
Department of Health (2005) The National Service Framework for Long-term Conditions
[Internet]. Available from:
<http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digit
alasset/dh_4105369.pdf> (Accessed: 7th November 2010).

Department of Health (2004) NHS Improvement Plan: Putting people at the heart of
public services [Internet]. Available from:
<http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents
/digitalasset/dh_118572.pdf> (Accessed: 21st November 2010).

Department of Health (2001) The expert patient: a new approach to chronic disease
management for the 21st century [Internet]. Available From:
<http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/document
s/digitalasset/dh_4018578.pdf> (Accessed: 28th November 2010).

Devitt-Jones, S. (2007) Critical thinking in Health and Social Care, London: Sage
Publications.

Eldridge, S. Foster, G. Griffiths, C. Ramsay, J. Taylor, S. (2007) How effective are expert
patient (lay led) education programmes for chronic disease? British Medical Journal, 334
(7606): 1254 – 1256.

Eraut, M. (2003) Developing Professional Knowledge and Competence. London:

Routledge Falmer Press.

Evidence-Based Occupational Therapy (2009) What is evidence-based practice?

[Internet]. Available from: <http://www.otevidence.info/ebp_page.asp?pageid=5> (Accessed:
22nd November 2010).

Goldblatt, D. (2004) Knowledge and the Social Sciences Theory, Method and Practice,
2nd Ed. London: Routledge.

Griffin, A. (2007) UK nears European average in proportion of GDP spent on health care.
British Medical Journal, 334 (7591): 442

Page 15 of 20
Hatfield, A, B. and Lefley, H, P (2003) Families of the mentally I’ll: Coping and adaption.
United States of America: Guilford Press.

Health Services Research Unit (2010) The needs and experiences of services by
individuals with long-term progressive neurological conditions and their carer’s
[Internet]. Available from: <http://www.ltnc.org.uk/download_files/final
%20reports/Needs_and_Experiences_Exec-summary.pdf> (Accessed: 21st November
2010).

Heywood, A. (1998) Political Ideologies: An Introduction, 2nd Ed. Basingstoke: Palgrave

Macmillan.

HM Government (2010) Petition to: deliver on the rights of every person with multiple
sclerosis to world-class healthcare, to independence and to support to lead a
full life [Internet]. Available from:
<http://www.hmg.gov.uk/epetition-responses/petition-view.aspx?epref=MSRights>
(Accessed: 9th November 2010).

HM Treasury (2010) Budget: Responsibility Deficit Reduction [Internet]. Available From:

<http://hm-treasury.gov.uk/junebudget_responsibility.htm> (Accessed: 24th November 2010).

House of Commons Trade and Industry Committee (2005) Progress towards the
Knowledge Driven Economy: Governments Response the Committee’s Eight report of
Session 2004-05 [Internet]. Available From:
<http://www.publications.parliament.uk/pa/cm200506/cmselect/cmtrdind/364/364.pdf>
(Accessed: 24th November 2010).

Marx, K. (1846) in K. Marx and F. Engels (1976) The Communist Manifesto.

Harmondsworth: Penguin.

Multiple Sclerosis Society (2010A) Support and Services [Internet]. Available from:
<http://www.mssociety.org.uk/support_and_services/respite_care/index.html> (Accessed: 9th
November 2010).

Page 16 of 20
Multiple Sclerosis Society (2010b) How to Help in Looking After Someone [Internet].
Available from: <http://www.mssociety.org.uk/downloads/Guidance_for_carers_-
_carers_assessment.a9053b50.pdf> (Accessed: 9th November 2010).

Multiple Sclerosis Society (2010c) Findings of the Review [Internet]. Available from:
<http://www.mssociety.org.uk/downloads/Respite_care_review_Report_to_Board_June_201
0.7943f510.pdf> (Accessed on: 9th November 2010).

Multiple Sclerosis Society (2010d) Support and Services [Internet]. Available from:
<http://www.mssociety.org.uk/support_and_services/information_services/index.html>
(Accessed: 10th November 2010).

Multiple Sclerosis Society (2010d) MS Society Respite Care Review [Internet]. Available
From:<http://www.mssociety.org.uk/downloads/Respite_care_review_Report_to_Board_Jun
e_2010.4dc148d5.pdf > (Accessed: 24th November 2010).

NHS Evidence (2010) Sources of information list [Internet]. Available from:

nd
<http://www.evidence.nhs.uk/aboutus/Pages/SourcesList.aspx> (Accessed: 22 November
2010).

Nursing Times (2008) NHS Nursing in the 1950s [Internet]. Available From:
<http://www.nursingtimes.net/nhs-nursing-in-the-1950s/461928.article> (Accessed: 28th
November 2010).

Organisation for Economic Co-operation and Development (OECD) (1996) The knowledge-
based Economy. Paris: OECD.

Powell, W, W. and Snellman, K. (2004) ‘The knowledge economy’. Annual Review of

Sociology, 30: 199 - 220.

Silverman, A. (2008) Metaphysics Research Libratory Stanford University, Plato's Middle

Period Metaphysics and Epistemology [Internet]. Available from:
<http://plato.stanford.edu/entries/plato-metaphysics/> (Accessed: 16th October 2010).

Steup, M. (2005) Metaphysics Research Libratory Stanford University, Epistemology

[Internet]. Available from: <http://plato.stanford.edu/entries/epistemology/> (Accessed: 16th
October 2010).

Page 17 of 20
The Independent (2010) MS Societies Plans to Close Care Homes Angers Membership
[Internet]. Available from: <http://www.independent.co.uk/life-style/health-and-
families/health-news/ms-societys-plan-to-close-care-homes-angers-membership-
2088108.html> (Accessed: 9th November 2010).

The Telegraph (2010) Would a coalition government want to tackle the deficit?
[Internet]. Available From:
<http://blogs.telegraph.co.uk/news/danielhannan/100035637/there-was-a-time-when-
proponents-of-coalition-government-were-serious-about-cutting-debt/> (Accessed: 27th
November 2010).

Page 18 of 20
Annotated Bibliography

Blackler, F. (1995) Knowledge Work and Organisations: an Overview and Interpretation.

Organisation Studies, 16 (6): 1021 – 1046. Blacklers explanation was used as a
standalone piece of information to outline some different knowledge types. Blacklers
explanations were adapted and related to MS respite centres and other parts of the
assignment thus far, this was in an attempt to highlight differences in knowledge and where
these knowledge types are generated from. Having read around Blacklers work there was
evidence to relate his activity theory and activity systems to this assignment and proved to
be a valuable model in which to capture the cognitive dimension of business knowledge.

Devitt-Jones, S. (2007) Critical thinking in Health and Social Care, London: Sage
Publications. Devitt-Jones sets out to equip both academics and practitioners with the
knowledge that is needed to look at any given situation within Healthcare and be able to
critically evaluate each given situation. This source of information was used to inform on
background of knowledge production and show the different perspective from theorists’. I
found it gave a well rounded overview of the transition from knowledge industry as a society
to the current production economy. Devitt-Jones gave an easy to interpret account of the
professional autonomy which in turn gave me an understanding of how knowledge becomes
privileged and knowledge authenticity. One of the main uses of this book was to inform on
the social construction of knowledge and its dependence on personal ideology.

Department of Health (2005) The National Service Framework for Long-term Conditions
[Internet]. Available from:
<http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digit
alasset/dh_4105369.pdf> (Accessed: 7th November 2010). The NSF document provided
sound and current information on the governments 10 year commitment to long term
neurological conditions. This source of information provide one of the main knowledge
frameworks used within the assignment, I found it useful when considering a client centred
approach and in turn how that fits with the complexities of Multiple Sclerosis. This document
also provided a good example of embedded knowledge when considering different concepts
of knowledge.

Page 19 of 20
Hatfield, A, B. and Lefley, H, P (2003) Families of the mentally I’ll: Coping and adaption.
United States of America: Guilford Press. Provided a sound historical source of knowledge
when considering social philosophy of how the provision of health and care was viewed from
the 17th century through to the 20th century. Highlighting the misconceptions of modern day
illness, for example: MS, Dementia and Learning disabilities as purely mental illness. Having
looked for alternate current evidence I found the information surrounding MS and the
historical development of respite care to be lacking, hence the date of this information
source. This information also informed on the cultural and material (medication, doctors and
services) difference within today’s society.

Multiple Sclerosis Society (2010a) How to Help in Looking After Someone [Internet].
Available from: <http://www.mssociety.org.uk/downloads/Guidance_for_carers_-
_carers_assessment.a9053b50.pdf> (Accessed: 9th November 2010). All MS web links used
within this assignment provided the basis for any MS statistical representation within the
assignment. The evidence found and used was both factual and reliable. I also found that
starting from the MS homepage there was a wealth of information linked to government
papers, surveys and other official reports that have been discussed and or critiqued.

Nursing Times (2008) NHS Nursing in the 1950s [Internet]. Available From:
<http://www.nursingtimes.net/nhs-nursing-in-the-1950s/461928.article> (Accessed: 28th
November 2010). Article evidence was used to inform on the NHS in the 1950, this allowed
me to explain how knowledge was limited to those of authority (authoritarian) in turn leading
the privileging of knowledge. These opinions were informed from a nurses point of view and
the patients perspective, both of which were then compare with current nursing and
organisational structure within the NHS today. It showed clear progression in current health
professional education and technology and how this development has aided progression
within the NHS of today.

The Independent (2010) MS Societies Plans to Close Care Homes Angers Membership
[Internet]. Available from: <http://www.independent.co.uk/life-style/health-and-
families/health-news/ms-societys-plan-to-close-care-homes-angers-membership-
2088108.html> (Accessed: 9th November 2010). Primary evidence was used from the
Independent news paper to give a contrasting experience of two people with similar ages,
sex and backgrounds, when asked about the closure of the MS respite centres. It was used
in conjunction with Goldblatts, 2004 view of social construction of knowledge, showing the
different ideologies of people accessing respite centres. Its purpose was to show that the
needs of people with MS are diverse and that experiences had are as diverse as the disease
itself.

Page 20 of 20