Shared Learning (S/L) refers to education initiatives whereby staff within
different professions working within Welfare Services undertake an education
programme which has been jointly validated by their national education
bodies. The purpose of this research study is to explore the nature of the
collaboration between Nurse and Social Work Education Departments within the Manchester/Salford S/L Scheme. This is the most recent of only three such programmes presently operating within England. These courses provide joint qualification in Registered Nurse (Learning Disabilities) and a Diploma in Social Work. The author wanted to investigate the course purpose and the roles played by contributing agencies prior to its commencement in March 1995, as perceived by key members of the course planning/management team.

The introduction considered characteristics of S/L and raised key matters of controversy. The Literative Review charts the growth of the concept in two phases. Firstly the Socio-Political context notes the changing legislative and professional framework in which it has operated. Secondly a chronology of such schemes attempted to date is given.

The aims of the study are noted above regarding its purpose. The methodology section considers the rationale for selecting an interview data collection tool. Thereafter an account is provided of the interviewees responses. These are analysed (within the discussion section) employing management of role change criteria.

Key conclusions of the study reveal a significant consensus existed between course planners regarding issues of its structure and the desired operating conditions. Firstly, they agreed the purpose of the course was to merge the skills of Nursing and Social Work, as applied to Learning Disabilities Services, within a single future practitioner. Secondly, that the management of such schemes requires a strong commitment from a wide range of interested parties in order to overcome bureaucratic differences remaining between Nursing and Social Work professional regulations. Some differences remain between perceptions of interviewees based on their professional background and the roles played within their respective organisations.

Research undertaken by Statham (1991) investigated role expectations of Nurse Tutors (Mental Handicap) within Project 2000 (P2K) curriculums emerging from 1989. Most respondents believed P.2.K provided a secure base for their professional development. However they recognised that Learning Disabilities (L.D.) services would progress along a social rather than Medical model of care.

Shared Learning (S.L.) initiatives are one manifestation of this trend. The Central Council for Education and Training of Social Workers and the English National Board, CCETSW/ENB (1986) define its earlier form 'Joint Training' (J.T.) as follows:-

'That Training/Education in which learning occurs mutually between students within the entirety of educational programmes which have been validated by both statutory bodies for all students'. Three such courses presently entitle the qualifying students to practice either as a Registered Nurse (Learning Disabilities) (R.N.\L.D) or a generic Social Worker. The rational e lies in the perception that such personnel operating in L.D. services share significant common ground in professional knowledge and skills.

The S/L approach suggests an individual can progressively acquire competencies required of both nurses and social workers within one integrated educational programme. Would such a 'hybrid' student inevitably suffer professional role- confusion?

Such a course requires mechanisms for Joint Assessment of both theory and practice, to be undertaken by educationalists and suitably qualified practitioners. Is this scenario not a recipe for much inter-professional wrangling and a bureaucratic minefield?

Diploma in Social Work (D.S.W.) and P.2.K. course taken separately require five years to complete. The extra breadth and depth of study required within S/L courses is not reflected in the length of such programmes, which are three years in total. Does this suggest joint training schemes are driven by financial rather than educational motives? Will the course product be a Jack of both L.D. Nursing and Social Work trades but master of neither? Or will they be the genuine article: a Catalyst promoting more effective Multi-disciplinary teamwork within L.D. service provision.

The assignment explores such issues in two sections. The Literature Review analysis the growth of the S/L concept in L.D. professional preparation. Thereafter the planning of one such scheme is reflected on by key members of the course management team.

A. The Socio-Political Framework of Shared Learning

S/L initiatives need to be understood within the context of State Community Care policies of the last three decades. Better Services for Mental Handicap (1971) provided the initial blueprint for Nurses and Social Worker collaboration within non- institutional L.D. settings. The primary vehicle for these were Community Mental Handicap Teams (C.M.H.Ts).

Two decades on the Community Care Act (1990) represented arguably the most significant legislation this century for L.D. Services, conferring lead agency status on Local Authorities. Brown (1995) notes this ended thirty years of debate regarding the roles of these bodies and their respective Health Authorities. Subsequent government reports - Department of Health/Social Services Inspectorate (D.O.H./S.S.I.) (1991, 1993) and Adult Commission (1992a, 1992b, 1992c) approved of S/L as a professional training strategy consistent with state policy. Further, the Act established National Health Service (N.H.S.) Trusts which would serve as primary purchasers of such training packages.

Reforms within key professional bodies during this time established the framework which facilitated the necessary collaboration. The Nurses Act (1979) replaced the General Nursing Council (G.N.C.) with the executive United Kingdom Central Council (U.K.C.C.) and training validation bodies, of principal relevance being the E.N.B. The creation of CCETSW (1982) provided such professionals with a national organisation whose responsibilities mirrored those of the E.N.B.

The progressive strengthening of links between Nursing and Social Work training departments and Higher Education Institutions (H.E.Is) was also significant. Initially, Joint Training (J.T.) occurred only at post-qualifying level, for example Keele University Diploma/Masters Degree studies in L.D. from 1974. Since 1989 training courses allowing access to both professions have had parity of academic accreditation - Diploma level studies. Finally all Colleges of Nursing and Schools of Social Work in England will be incorporated within H.E.I.s during 1996. Research by Statham (1991) indicated 79% of R.N. (L/D) Tutors viewed such a prospect favourably.

Guidelines for R.N. (L/D) roles increasingly suggested an overlapping with those of Social Workers in L.D. Community Services. These included the Nurses Act (1979) GNC (1982), Community Mental Handicap Nurses Association (1985), UKCC (1986) Royal College of Nursing (RCN) (1988) and Department of Health (D.o.H.) (1989).

The radical role change from Institutional Care to Community Care found increasing support within RN (L/D)s themselves (Reed 1987). This related to the spectre of professional extinction threatened periodically-Briggs (1972), Jay (1979), ENB (1989), D.o.H. (1993). Projected reductions in RN (L/D) employment by Regional Health Authorities (R.H.A.s) for 1990 - 1993, 50% in Mersey RHA, Nursing Times (1990), and 16% in North West R.H.A. (1990) reinforced such fears.

B. Shared Learning Initiatives - (L/D) Nursing/Social Work.

Joint Training (J.T.) initially involved RN (L/D)s linking with Registered Mental Nurses (RMN.s) on Polytechnic community nursing courses from the mid 1970s. Nine such programmes were operating nationally in the mid 1980s (Reed 1987). A mix of generic and specialist theory supplemented client-specific practice experience, learning to a Community Nursing academic award at Certificate level.

P.2.K. courses established nationally by 1993 include a S/L experience for all students in both theory and practice during the initial Common Foundation Programme (C.F.P.) eighteen months period. When completed, a certificate level academic 'credit' it awarded to the student who is thereafter (theoretically) able to access any of the Nursing Branch programmes. C.C.E.T.S.W. (1991) facilitate a variety of routes by which the D.S.W. qualification, established nationally between 1989-1993, could be attained. For example, six pathways are currently approved within University College, Salford (U.C.S.) (1994) course structure.

J.T. between RN (L/D)s and Social Workers stem from their shared experience within C.M.H.T.s referred to earlier. These were established as a national network during the decade from the mid 1970s (Reed 1987). Such multi-disciplinary agencies were endorsed and guided in their structure and functional operation by recommendations of the National Development Group (1976) and Model District Service, (1982). In 1993 they became administratively 'single services' led by a RN (L/D) or Social Worker as managers. 'Challenging Behaviour' Community Nursing Services became Additional Support Teams (A.S.T.s) and newly created Assessment Teams both reflected their RN (L/D)/Social Worker joint-professional composition.

Service Brokerage, a social welfare model for empowering service users to take a central role in shaping L.D. services developed in Canada from the late 1960s (Brandon and Towe 1989). The 'Service Brokers' skills were a 'hybrid' amalgamation of those practised separately by RN (L/D)s and Social Workers within C.M.H.Ts. They argued that the Service Broker role was well suited to meet the requirements the 'client needs-led' service, then being advocated by the State (D.o.H. 1989).

From their inception, Nursing and Social Work national training bodies recognised the potential benefits of Joint Training between their respective professionals within C.H.M.T.s. A series of joint reports, C.C.E.T.S.W./G.N.C. (1982, 1983), and C.C.E.T.S.W./ENB (1986), led to a pilot J.T. scheme - East Sussex in 1984 and courses in Essex and Kent from 1988 (Brown 1994). These were purely inter- professional ventures, awarding the Certificate in Social Services (C.S.S.) and RN (L/D) qualifications within a three year programme.

The Essex/Kent J.T. schemes ended in 1993. Course sponsors - R.H.A.s acting as training purchasers - judged them to have failed (Brown 1994). While remaining of the view that J.T. was 'a good idea' they considered the high student wastage rates to be unacceptable. In the worst case (first course of the Essex scheme), only two of five qualifiers from eleven starters - took up posts within sponsoring authorities. Further, changing priorities - establishing N.H.S. Trusts, P2K and D.S.W. courses - deflected Health/Social Service partnerships from maintaining the commitment required to overcome problems associated with this innovative programme.

Earlier, Wood (1991) reported the views of students on these courses. While supportive of the Hybrid Worker Concept, they perceived programmes to be 'disjointed'. Nursing and Social Work theory were taught on separate sites which fostered communication difficulties. Course tutors from both professions concurred with this criticism. Moreover, they recognised that differences in teaching approaches - Nursing being didactic and Social Work more discursive/experiential - created tensions between course implementors and confusion for students. A contemporary survey of RN (L/D) Tutors found 18% advocating pre-registration J.T. for (L/D) nursing students - alongside Social Workers (10%) and R.M.N.s (4%) (Statham 1991).

Following the Community Care Act (1990), the breadth of professional interest in S/L widened. Reports were undertaken by the UKCC (1992), RCN. (1992) and CCETSW (1990, 1992) alone. CCETSW/ENB (1990, 1992) joint reports changed the terminology from 'Joint Training' to 'Shared Learning', to reflect raised academic expectations of such programmes and their greater integrated nature. The clinical scope of such interest expanded. Brown (1995) noted that six pilot schemes in Elderly and Mental Health services commenced in 1990.

Opinion leaders from both professions advocated the case for S/L. Elliot-Cannon (1988), (1989) from Nursing, and Walton and Brown (1988), Brown (1992), (1994), (1995) and Bowdler (1992) from Social Work. Support was also registered amongst RN (L/D) practitioners attending national forums, for example a COHSE/RCN Conference. (Nursing Times 1989).

A revised model for S/L courses in RN (L/D) Social Work was devised within the context of the reformed educational structures indicated earlier. Hence they were (at least ) Diploma level studies con-jointly validated by H.E.I.s, C.C.E.T.S.W. and the E.N.B. They commenced operation prior to the relative failures of the earlier model courses had been formally evaluated by Brown (1994).

The Portsmouth (1991) course design included a truncated C.F.P. of less than one year, and token non-L.D. practice experience of less than eleven weeks. Years two and three followed the D.S.W. course programme with supplementary (L.D.) Nursing theory and practice experience Commencing at Diploma level, the course has recently been re-validated at a Degree with Honours level (Portsmouth 1995).

'South Bank' (1993) commenced as a Degree with Honours Course. Its design involved such students engaging in S/L with, on occasion, other P2K students, and those on the BSc (with Honours) Nursing Course during the eighteen months C.F>P. During this period sixteen weeks of Non L.D. focused Clinical experience was gained. The remaining 18 months was largely shared with mainstream D.S.W. students. Twelve student bursaries were sponsored by the local R.H.A

In both cases, the students were viewed as being a distinctive group receiving all their theory together within the same University campus site, which housed departments of Nursing and Social Work.

An ENB (1993) imposed Moratorium, lasting fifteen months blocked any further S/L courses being brought forward for con-joint validation. This was directly related to the debate engendered by a D.o. H. (1993) proposal regarding the future of the RN (L/D) qualification. Opinion leaders within Nursing, such as Sines (1993) advocated the L.D. nursing branch be removed from P2K and become a post-registration specialist course. Others including Ward and McCray (1993) and Turnbull (1993) viewed such a prospect as ringing the death-knell of the RN (L/D) profession. Despite this controversy, seven S/L schemes remained in various stages of planning during this time (ENB 1994).

The Manchester/Salford (1995) course differed from the two 'revised model' precedents in several important respects. The twenty students were entirely subsumed within their respective P2K and D.S.W. cohorts except for specific theory sessions relating to L.D. studies. This involved all the theory, focused at Diploma-level, being delivered between separate H.E.I.s. The initial eighteen months of C.F.P. emphasized Nursing (at Manchester University) while the latter eighteen months predominantly focused on Social Work issues (Salford University). Thirteen weeks on non L.D. practical care experiences were programmed into the C.F.P.

In summary, the literature indicates over twenty years of growing collaboration between Nurses and Social Workers in both Education and Fieldwork structures of L.D. services. This experience of partnership nurtured by Social Policy directives, has encouraged a growing support for the view that both professional identities can be integrated within a single 'Hybrid Worker' (Brown 1994).

The overall aim of the research was to explore the nature of this collaboration within the most recent S/L venture, Manchester/Salford. To this end, the perceptions of four key planners - Project Leaders and Course Tutors from both educational institutions - were examined. Key issues included the course purpose and the relative roles played by contributing agencies in the planning process.

Specific questions relating to the nature of the collaboration between the key planners are noted below.

1. How did their respective professional backgrounds influence the perception of issues raised?

2. What impact did differences in professional perspectives have on the degree and style of co-operation displayed towards those from a different professional tradition?

3. Were there discernable sharing of perceptions on specific issues between levels of management, ie. project leaders views being different from those offered by Course Tutors?

4. What was the relative knowledge of key players regarding planning issues?

5. Have opinions/perspectives changed over the last year regarding matters raised relating to the course planning phase?

These questions were implicitl