Cover Page

Key Themes in Health and Social Care series

Nick J. Fox, The Body

Janet Hargreaves & Louise Page, Reflective Practice

Professionalism

ALAN CRIBB AND SHARON GEWIRTZ














Preface

This is, obviously, only one of the many short books about professionalism that could be written. One such book might usefully start by looking at codes of professional practice and reviewing and advocating the standards of behaviour and quality that apply to health and social care practitioners. What is required of practitioners, for example, when it comes to confidentiality, honesty or stewardship of scarce resources? Another book might begin from critiques of professional power and argue that professionalism is no longer a credible notion in contemporary social conditions. The latter text would have a predominantly sceptical, even dismissive, tone.

This book, although it covers similar themes and material, takes neither of these lines. We hope it is an encouraging text and one that might help support the understanding – and exercise – of professionalism. However, it does not take the idea of professionalism for granted. The two broad organizing questions that lie behind the book’s arguments are: Is professionalism desirable and is professionalism possible? Taking these questions seriously means not taking all of the social apparatus surrounding professionalism (for example, codes of practice and the professional bodies that issue them) at face value. It means standing back and asking about the visions, ideals and personal virtues that lie behind the language of professionalism, and asking whether or not these visions, ideals and virtues are meaningful and practicable for current health and social care systems and practitioners.

We believe, and will argue, that these questions can be answered in the affirmative. But in order to come to this conclusion, we suggest, it is first necessary to be clear about the many challenges posed by such questions, including the challenges of critics and sceptics. Much of the book’s focus is on professional dilemmas, but here our primary interest is not in the specific dilemmas that might face practitioners (for example, those concerning compulsory treatment, euthanasia, allocating budgets, etc.) but rather the fundamental dilemmas of determining what it means to be a professional in current working contexts. In very broad terms, this involves, for example, balancing a traditional emphasis on being an ‘autonomous expert’ with ever-increasing demands to be responsive and accountable to both service users and managers. Those occupying roles in health and social care operate under immense pressure not only from sheer volume of work but also from this constant need to balance competing perspectives and voices. What can and should professionalism look like under these circumstances?

We start, in chapter 1, by thinking about the image of professionals as socially special, and perhaps particularly admirable, individuals. How does this image connect to the fact that some professionals can do bad things? Our hope is to begin to shed light on how professional status and roles place people in relatively powerful positions – for good or ill. In chapter 2, we consider the idea that the language of professionalism has spread so widely and thinly as to become an empty public relations ‘brand’, but then go on to look for some core sense of profession that might properly underpin professionalism as an ideal. The difficulty this uncovers is that conceptions of profession and professionalism are not fixed – new versions of professionalism have emerged along with new expectations for health and social care practitioners. We track some of these changing conceptions, contrasting traditional conceptions of professionalism with some versions of ‘new professionalism’. In chapter 3, we seriously explore the idea that calls for professionalism are unrealistic – because changing social conditions and expectations make traditional conceptions of professionalism less relevant and because changing working conditions make the delivery of ‘new professionalism’ practically impossible, even laying aside question marks about its coherence as a version of professionalism. Whilst not accepting the thesis that professionalism is now a practical impossibility, we explore these issues to show just how challenging it is to formulate, practise and socially underpin forms of professionalism in the contemporary workplace.

In the remainder of the book, we set out to respond to these challenges. First, in chapter 4, we map out and illustrate a summary and ideal-type conception of professionalism – as the accomplished exercise of expertise-based social authority – that we think can stretch to serve current practice conditions and that embodies something both desirable and, at least to a degree, possible (albeit demanding) for many practitioners. This conception draws upon the discussions earlier in the book and, we suggest, is general enough to hold together different perspectives on, and versions of, professionalism but needs interpretation and application in contemporary conditions. We then set out to analyse and illustrate the dilemmas involved in both living out (chapter 5) and socially and institutionally supporting (chapter 6) this notion of professionalism. Our argument is that these dilemmas are inherent in professionalism – and that professionalism does not consist in identifying ‘what works’ so much as in being ready to question and debate what counts as working from case to case. These two chapters thus help to ‘fill out’ the general account of professionalism offered in chapter 4 for the conditions of contemporary health and social care. The account that emerges is of a ‘critically reflexive’ professionalism – a professionalism which is continuously negotiated with others and routinely combines relational as well as technical forms of expertise, which is ready to embrace critique and self-doubt, and which draws upon practitioners’ humanity and practical wisdom. This conception of professionalism also entails that practitioners will understand their work, and engage with it, with sensitivity towards broader debates about social and civic purposes. In chapter 7, the concluding chapter, we retell the story of the book by returning to the idea of individual practitioners, or at least their role models, as embodying admirable qualities. What kind of identities can and should practitioners aspire to and enact if they want to embody the ideals and virtues of professionalism in their working lives? Our intended audience here, as throughout the book, is practitioners who work in health and social care, but we imagine that the themes and topics we discuss will have many resonances for people working in other professional roles.

This book, in short, explores and reflects upon the complex and disputed territory of professionalism. We hope that it will stimulate readers’ own explorations and reflections; indeed, this is the primary aim of the book. Although we do offer arguments and observations of our own about the nature and importance of professional roles and professionalism, we are hoping that readers will approach the book not looking to take away ‘answers’ but rather to find material to think about. After all, we would suggest, professionalism entails being able to think things through and make judgements for oneself, albeit within frameworks of support provided by others.

Acknowledgements

We would like to thank all our colleagues in the Centre for Public Policy Research, King’s College, London for being wonderful people to work with and, more specifically, for many criss-crossing conversations relating to things discussed in this book which we have enjoyed over the years. We are also very grateful to Pat Mahony and Ian Hextall who co-organized an ESRC seminar series on professional identities and education with us which gave us the opportunity to think around the topic of professionalism. Huge thanks go to Vikki Entwistle and John Owens who provided very encouraging and constructive comments on an earlier draft of the book. Alan would also particularly like to thank the Health Foundation for funding which made the writing of this book possible and his colleagues there, including Adrian Sieff, Alf Collins and Nick Barber for support, stimulation and valuable feedback on ideas.

As before, it has been a pleasure to work with Polity Press. Emma Hutchinson and Pascal Porcheron have been patient, helpful and suitably challenging. We are grateful to them and also to the two anonymous reviewers whose comments, along with those from Vikki and John, were invaluable in helping us to complete the manuscript.