Introduction

This chapter analyses from a regulatory viewpoint the policy dynamics of health support work and complementary and alternative medicine (CAM) in the UK, as examples of marginal groups in the healthcare division of labour. Typically, in the past, social scientific studies of professionalisation have focused on fully fledged professions, at the expense of occupational groups with a less developed professional structure – not least in the area of health. Theoretically, this applies to traditional trait and functionalist approaches more positively oriented towards professions as much as to the more critical recent neo-Weberian orthodoxy based on the interests of such privileged occupations centred on exclusionary social closure in a competitive marketplace (Saks, 2003a). This emphasis is understandable given the longstanding, well-defined and high-profile forms of corporate governance associated with the leading health professions.

In healthcare, the medical profession has been the main focus among social scientists in the Anglo-American context. It was the first health profession historically to establish itself as ‘self-regulated’ in the UK through the 1858 Medical Registration Act (Stacey, 1992). As in the US where similar trends occurred by the early 20th century, this allowed medicine to dominate the rest of the healthcare workforce as the subordinated occupations allied to health began to professionalise (Saks, 2003b). Although the focus is progressively changing – with growing numbers of studies of professional groups like nurses and midwives in the healthcare division of labour (see, for instance, Davies and Beach, 2000) – medicine still steals the limelight in the published literature. In the UK, this is reflected in growing social scientific interest in the policing of medicine, which has long taken precedence over the regulation of other areas of healthcare (see, for instance, Klein, 1973; Rosenthal, 1987) – especially following the recent case of Dr Harold Shipman, the serial-killing general practitioner (Allsop, 2002).

In light of media publicity given to this and other incidents highlighting poor performance by doctors, medical regulation can once more be seen to be driving change to enhance public protection – a central plank of government policy in the health arena. However, government policy interest is now spreading to other health professions, as illustrated by the establishment of the Council for the Regulation of Health Professions – now retitled the Council for Healthcare Regulatory Excellence – to promote best practice in the regulation of healthcare professionals in the public interest (Larkin, 2002).