Gerard Hanlon

Professionalism as Enterprise: Service Class Politics and the Redefinition of Professionalism

This paper suggests that the struggle to redefine professionalism, which is currently being waged in a host of institutions from the National Health Service to accountancy practices, is actually a struggle to legitimise different types of cultural capital and that, as such, it will potentially split the service class. This cleavage reflects the decreasing levels of trust placed in social service professionalism and its adherents by powerful actors such as the state and capital. In the light of this, certain groups within elite occupations have sought to redefine professionalism and to prioritise commercial issues in a bid to gain the trust of these actors and to exploit opportunities which the attack on the social service ethos has presented to them. This cleavage extends across the public sector-private sector divide and it is also taking place within previously relatively homogeneous professions. If this cleavage persists, it may fragment the identity of the service class and lead elements of it to change their political identification. As such, it would challenge the thesis which is most closely identified with Goldthorpe, that the service class is homogeneous and conservative.

Knowledge, technology and nursing: The case of NHS Direct

NHS Direct is a relatively new, nurse-based, 24-hour health advice line run as part of the UK’s National Health Service (NHS). The service delivers health advice remotely via the telephone. A central aspect of the service is the attempt to provide a standard level of health advice regardless of time, space or the background of the nurse. At the heart of this attempt is an innovative health software called CLINICAL ASSESSMENT SYSTEM (CAS). Using a number of qualitative methods, this article highlights how the interaction between the nursing staff and this technology is key to the service. The technology is based on management’s attempt to standardize and control the caller-nurse relationship. Thus the software can be seen as part of an abstract rationality, whereas how it is deployed by nurses is based on a practical rationality that places practice and experience first and sees the technology and protocols as tools.

Institutional Forms and Organizational Structures: Homology, Trust and Reputational Capital in Professional Service Firms

This paper examines how professional service firms have used a combination of clan and bureaucratic control techniques to manage change over a 100-year period. Both sets of controls have been present throughout, but the mix between the two has altered to reflect changes in the broader institutional environment. These shifts create new contradictions that eventually undermine their very success. However, in the midst of these changes and shifts, the basic institutional features of homology, trust and reputational capital have continued to structure these professional arenas.

Risk and the Responsible Health Consumer: The Problematics of Entitlement among Callers to NHS Direct

NHS Direct, the 24-hour telephone helpline, uses modern communications technology to offer easier and faster access to advice about health, illness and the NHS so that people are better able to care for themselves and their families. In-depth interviews with callers to the service show that they bring with them discourses of the ‘deserving’ and ‘ undeserving’ familiar in the provision of other welfare services. The figure of the ‘time-waster’ is the NHS equivalent of the welfare ‘scrounger’, acting as a mechanism to problematize entitlement. NHS Direct dispels such fears and legitimizes demand. At the same time, ever-rising levels of service use constitute a threat to what callers value most about it.

Male callers to NHS Direct: the assertive carer, the new dad and the reluctant patient.

It has been suggested in the light of mortality and morbidity rates, and men’s reluctance to seek medical help and advice, that there is a crisis in men’s health. Little is known about men’s experiences of using health care services, despite an emergent UK men’s health movement. NHS Direct, the new telephone advice line, was designed to be more accessible, convenient and responsive to the public’s needs for health care. In-depth interviews with male callers to the service, aged between 29 and 59, reveal that they sought help in their roles as fathers, partners and on their own behalf. Having used it once, they anticipated doing so again. Their learning about health matters, from both the formal structure and the informal agenda of the telephone consultation, suggests the potential of men’s use of this service for ‘normalizing’ help seeking by men, and thereby for longer-term improvements in men’s health.

‘Pathways to the Doctor’ in the Information Age: the Role of ICTs in Contemporary Lay Referral Systems

Just over three decades ago Zola (1973) published a paper with the title ‘Pathways to the Doctor: from person to patient’. This seminal work became one of the most influential and cited articles in medical sociology. Based on an empirical analysis of patients’ accounts of their reasons for attending a hospital outpatients in the USA Zola identified his five now famous ‘triggers’ (see below), which prompt consultation with formal health care providers. But of course there have been substantial socio-economic, political and technological transformations since Zola carried out his fieldwork. The late 1960s and early 1970s was a period that is characterised as being an era of Fordism, modernism, professionalism, industrialism and so on. This is in contrast to the post-Fordist, late modern, consumerist, information age which is presumed to more accurately capture the features of contemporary life. The aim of this chapter is to reconsider the work of the likes of Zola and his contemporaries in order to assess whether and to what extent his analyses of ‘pathways to the doctor’ still have any analytic purchase in relation to people’s routine experiences of health care. The chapter argues that while continuities can be discerned over the last 30 years there are also changes; imperceptible perhaps at the level of everyday practice but occurring nevertheless.

The First Neo-Liberal Science: Management and Neo-Liberalism

There has been much recent scholarship on the nature of neo-liberalism. What follows develops these connections by examining early neo-liberal and management thought. The article explores the foundations of neo-liberal and management theory to argue they share fundamental features – namely active intervention, prioritising competition and the necessity of elite leadership. The purpose of all three is to reshape subjectivity and social relations. This exploration argues both projects share similar origins and that the objective of neo-liberalism, wherein subjectivity and social relations are changed along competitive lines, lies at the heart of the management programme.

Digging deeper towards capricious management: ‘Personal traits become part of the means of production’

What follows examines the shifting nature of work to argue that we need to look beyond the employment relationship and the work organization to understand labour. It suggests one tendency in capitalism is to generate ‘all labour as productive of value’ (Harvie, 2005: 161), so that we subsume life to work. The article also suggests that, rather than being new, this development is an intensification of the past. Indeed, by returning to early management writers, it asserts that we can see the scale of management’s political ambition to subsume life to work. As such, to understand labour we need to comprehend the broader issue of capitalism’s social reproduction and the manner in which it recalibrates the subject as a ‘subject of value’.

The New Securocracy and the “Police Concept” of Public Sector Worker Identity

Abstract In recent years we have seen the emergence of a “new securocracy,” a generalization of responsibility for fighting terror within the public sector. Here we consider the nature and extent of this securocratic shift. In particular, the identity implications for the public sector worker are explored and we contend that there is an inherent tension between “serving” and “policing” the public in many public sector jobs. We also discuss the way in which a securocratic identity is simultaneously embraced and resisted. Finally, we present some tentative insights into an alternative way of thinking about identity work, which offers a means of extending conventional interpretations.