Introduction: health professionalisation, risk and the public interest

This chapter discusses the limited regulation and management of risk in the work of support workers in health and social care compared to the more rigorous regulation of health professionals. It is evident that health care systems in the modern world are increasingly dependent on such workers. This is in part due to growing demand from ageing populations with multiple health and social care needs that require a mix of skills to provide care, but also to shortages in the supply, and the cost of, highly trained professionals (McKee et al 2006). Here, a neo-Weberian perspective has been adopted to analyse the role of professional groups in the health care division of labour. The focus is on the UK and particularly on England as policies now differ from Northern Ireland, Scotland and Wales. This perspective takes the stance that professions have gained exclusionary social closure over particular areas of work, underwritten by the state in a competitive marketplace (Saks 2010). Such closure has involved the establishment of registers on which appear the names of a limited group of those eligible, who typically have the requisite graduate level educational credentials and are subject to ethical codes and mechanisms of disciplinary enforcement. This has allowed the development of policies for the regulation and management of risk. By comparison, health support workers, a large and heterogeneous group, are less subject to entry requirements and regulatory oversight. As highlighted in various chapters of this book, this is the case in a number of other modern countries.

For the health professions, self-regulatory, monopolistic arrangements have been the norm. This form of regulation has been theorised in different ways. For example, functionalist writers have seen selfregulation as in the public interest, in which a profession regulates specialised expertise of great value to society on behalf of the state. In this arrangement, a monopoly to practise is gained as a trade-off and the profession is collectively rewarded by enhanced income, status and power (Goode 1960). Later theorists of the professions have viewed this as part of the occupational rhetoric of professionalism.