There are many forms of public service delivery – providing healthcare, policing, educating children, assisting unemployed citizens in finding work – and in many ways, these services depend on professional workers. Policemen, medical doctors, nurses, teachers and welfare workers deliver services to clients. Although there are many types of professionals and it is difficult to define professionalism in clear and consistent ways, public service professionals have a few things in common. They primarily deal with clients – as cases, often complex cases – but they also serve public goals, such as safety, public health and employment. This case treatment is regulated by many rules...

This chapter offers an account of a body of research relating to professions and professionalism in the UK public sector which the author has undertaken with colleagues over a thirty-year period. At the start of this period, following the election of a Conservative government in 1979, there was the introduction of a distinctive new policy. A decisive break with the past, this policy was collectively identified as New Public Management (NPM) (Exworthy & Halford 1999; Ferlie & Fitzgerald 2000). The general direction of policy did not change much thereafter, despite changes of administration and the election to power of different...

The role of ‘public’ professionals is one that has continually been contested. They are the bearers of forms of knowledge and expertise that the public value, but at the same time the public – in various manifestations – has often resisted or resented the power of professionals to make judgments about their lives and to broker access to the resources they need. It is professionals who are entrusted with the impossible job of reconciling ‘needs’ and ‘wants’ and of managing the relationship between the hopes and fears of those they serve. Professionals are also the carriers of all of the contradictions of...

Full and semi-professionals appear to have more in common than their distinction suggests. They experience pressures on the way they do their work, and they feel these pressures have increased. In the preceding chapter Janet Newman showed that increasing pressures on professionals can be explained in two ways. First, existing pressures have exacerbated, and, second, new kinds of pressures have arisen. Her focus on pressures within knowledge-power knots illustrates that these pressures are relative, depending on the perspective that is taken. Whereas some professionals might be troubled by pressures and seek ways to cope, others might be consciously causing pressures...

Long ago, professionals were seen as neutral experts who used their skills and knowledge for the betterment of society. This functionalist perspective on professionalism, embodied in e.g. the works of Emile Durkheim (1957), treats professionals as the bearers of important social values. Professionals are defined by the idealtypical traits of their profession, as described in the previous chapter, including a body of abstract and specialized knowledge and professional values. The idealtypical image of the impartial professional who uses his expert knowledge to the best interest of his clients is under attack since Ivan Illich’s (1976) famous criticism of the medical...

Elements of New Public Management have also made their entrance in the legal professional world. The Dutch judicial organization has been reorganized in order to improve its transparency and efficiency, backed by the budgetary incentives employed by a supervisory board of adjudication (the so-calledRaad voor de rechtspraak) and the Ministry of Justice (e.g. Mak 2008a, 2008b). This fits with a changed legal culture: the judiciary is confronted with a critical general public that no longer takes its authority and traditional institutions for granted. Those who seek justice claim a right to transparent and efficient adjudication and so does the...

Earlier in this book Van der Veen already briefly discussed NPM-related changes in the Dutch healthcare system. His overall conclusion was that these changes appear to limit the autonomy of professionals, but not their discretion. In this chapter, a specific far-reaching change in the Dutch care system – most specifically in Dutch mental healthcare – will be discussed. I will examine how the use of financial instruments creates pressures for professional conflict and change. This chapter describes the introduction of Diagnostic Treatment Combinations (in Dutch Diagnose Behandel Combinaties or DBCS) in the mental healthcare field, and analyzes the challenges this financing system...

The chapters of Van der Veen and Hupe & Van der Krogt explored professionals and professionalism in general, as well as the nature of the pressures they face. In this chapter, we explore the pressures faced by professionals when implementing public policy programs. This is relevant, as many of the pressures exerted on professionals are related to the policies that are implemented (Duyvendak et al. 2006; Freidson 2001). In terms of Newman’s knowledge-power knots (chapter 3), this chapter will specifically focus on the public professional in his relationship with the government. It will also illustrate how this unilateral relationship of...

Hupe & Van der Krogt discerned three different modes of dealing with pressures available to professionals: coping, networking and activism. In the preceding chapter Tummers, Steijn & Bekkers showed that certain types of professionals differed in their coping strategies, backed by their professional orientation.

In this chapter we will elaborate on this. We will describe how public sector professionals – street-level professionals, to be more precise, who possess ample discretionary powers – deal with clashes and tensions between values, interests, and loyalties. They face multiple work influences, which cannot be respected all at once. For public sector professionals, such tensions are part...

The concept of NPM and its consequences for professional work have already been discussed in previous chapters of this book. Newman stressed that NPM is not a singular entity, but a wide range of reforms that have been enacted and experienced very differently in various countries. Nevertheless, the overview of Hood (cited in the contribution of Tummers, Steijn & Bekkers) can be seen as giving the essence of what is generally meant by the introduction of NPM reforms. In this chapter we will especially focus on the second component mentioned in Hood’s overview, e.g. the introduction of explicit standards and...

In this chapter we analyze what we call ‘regulatory pressure’. By this we mean the pressure experienced by individual professionals because they feel encapsulated by rules and standards. As such, it is related to the three general sources of pressures discerned by Hupe & van der Krogt as having an impact on professional work (rule pressure, societal pressure and vocational pressure) and it is related to Tummers et al.’s emphasis on policy pressures and alienation effects. But regulatory pressure has a distinctive meaning referring to the combined effect of different rules and standards (linked to different policies) in daily work...

Over the past decades, developed welfare states have gone through major reform processes. In the field of employment benefits, one of the main objectives of these reforms was to ‘activate’ social security arrangements for unemployed people who are able to work and, thus, to promote labour-market participation and reduce welfare dependency (Gilbert 2002). These reforms affected substantive and operational characteristics of welfare states (Borghi & Van Berkel 2007). Not only the entitlements and obligations of unemployed people have changed, but also the ways in which social security arrangements are administered and social services are provided. Many countries introduced forms of...

In earlier chapters, we have seen that managers and their management instruments are blamed for exerting pressures on professional organizations and professional work. In this chapter, we will not deal with professionals on workfloors and their relations with managers, but we focus on managers themselves. Increasingly, in sectors like policing, education and healthcare, managers try to become professionals. Not so much as ‘managers’ , but as ‘leaders’ of organizations that are pressurized by bureaucratic control and performance demands (e.g. Farrell & Morris 2003; Ackroyd et al. 2007).

We do this for two reasons. First and foremost, we show that the...

In the previous chapters, pressures on professionals have been analyzed from multiple angles, based upon different conceptual and empirical analyses. It is now time to draw conclusions and propose ways forward. In doing so, we will explore the ‘state of professionalism’ with critical and political points of view that transgress Dutch borders. We will do this by returning to the various themes or parts that made up this book:I. Professionals and (managerial) pressures,II. Controlling professional practices, andIII. Organizing professionalism. After a short summary of the main findings we will outline the main points of our own perspective...