Despite the best intentions of policy makers and practitioners alike, plans do not always turn out as expected. The ‘implementation gap’ is a phrase that is often used to refer to the difference between what a particular policy promises and what is delivered in practice. This gap (or deficit as it is sometimes called) is a rather contentious affair and vast tracts have been written about it over the past 30 years in terms of what this looks like in practice; what can be done to overcome it; who is responsible; and, even in some cases, whether it actually exists at all. Debates over the implementation gap have become more pronounced in health and social care in recent years as emphasis has grown on evidence-based policy, practice and medicine.

As the sub-heading at the top of this page suggests, some of this literature is made up of accounts of policy makers blaming practitioners for failing to ‘properly’ implement their policies or accusing those on the front line of actively seeking to sabotage their policies. Who can forget Tony Blair speaking about ‘the scars on his back’ (Blair, 1999) that he bore following his attempts to persuade public sector staff to accept reform processes? Blair even went on to suggest some public sector workers were sabotaging the government's reform efforts. In a 2002 speech he talked of ‘wreckers’ who were trying to undermine modernisation efforts (Blair, 2002). Yet there are countless accounts of policies that have been deemed difficult or impossible to implement as they fail to sufficiently take into consideration important local contextual factors and therefore render policies unworkable in practice. How many times have we heard statements like ‘That's all very well but it will never work here because…’? So, what is happening here? Is it that we have professionals and practitioners who deliberately go against the will and hard work of policy makers (and politicians) as an act of defiance or rebellion? Or, is it the case that policy makers are so removed from ‘real life’ that they create policies that are unworkable once they reach the front line? Like most things in life, the answer to this question is neither simple nor straightforward and the truth lies somewhere in between.