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Policy, People, and the New Professional

Policy, People, and the New Professional: De-professionalisation and Re-professionalisation in Care and Welfare

Jan Willem Duyvendak
Trudie Knijn
Monique Kremer
Copyright Date: 2006
Pages: 222
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  • Book Info
    Policy, People, and the New Professional
    Book Description:

    Engaging with the acclaimed American sociologist Eliot Freidson's argument about professionalism's 'third logic' (a viable alternative to bureaucracy and consumerism), Dutch, British, French and German contributors to this volume bring together three political and academic debates rarely tackled jointly: professionalism, change, and policy, in the context of the increasing marketization and bureaucratization of healthcare and welfare. As attempts to cope with Europe's increasingly ageing and multicultural societies are being implemented, this first title in a uniquely positioned series provides an exhaustive analysis of the road travelled so far. This title is available in the OAPEN Library -

    eISBN: 978-90-485-0425-1
    Subjects: Political Science, Health Sciences, Sociology

Table of Contents

  1. Front Matter
    (pp. 1-4)
  2. Table of Contents
    (pp. 5-6)
  3. 1 Policy, People, and the New Professional An Introduction
    (pp. 7-16)
    Jan Willem Duyvendak, Trudie Knijn and Monique Kremer

    In the 1970s and 1980s, scholars were loudly criticising the power and intentions of social professionals. Three decades later, one hears a different voice, that of professionals whose power, expertise and knowledge are being undermined, which is causing serious problems. During an interview, Bourdieu (1998) said that the right hand of the state does not know what the left hand is doing. In other words, technicians, bureaucrats and policymakers have no clue about the work of those who actually implement public policy, such as teachers, policemen and social workers. As a consequence, the knowledge of what is really going on...


    • 2 The Rise of Contractualisation in Public Services
      (pp. 19-33)
      Trudie Knijn and Peter Selten

      Contractual governance, a term introduced by Yeatman (1994), is gaining ground in the social services. The concept refers to a fundamental change in the governing of social services. Governance implies a new way of directing and controlling the provision of services; the well-known expression ‘steering, not rowing’ means that governments are withdrawing from the direct responsibility of providing services themselves or from directly subsidising on an input basis non-profit organisations that are responsible for providing such services:

      Complexity, dynamics and diversity has led to a shrinking external autonomy of the nation state combined with a shrinking internal dominance vis-àvis social...

    • 3 Evidence-Based Policy From Answer to Question
      (pp. 34-47)
      Giel Hutschemaekers and Bea Tiemens

      Between the years 1980-1990, the Osheroff case aroused the emotions of many psychiatrists (Kaasenbrood 1995: 10-15). Osheroff suffered from serious depression. Following the failure of treatment with medication, he was admitted to Chestnut Lodge,¹ where he was treated for seven months using clinical psychotherapy without medication. His condition deteriorated to such an extent that his family requested a different treatment. When this request was not honoured, the family decided to have Osheroff transferred to another clinic. Here he was treated with medication. Osheroff’s condition quickly improved, and after three months he was discharged completely free of symptoms. However, this is...

    • 4 Societal Neurosis in Health Care
      (pp. 48-63)
      Margo Trappenburg

      In 1994, Michael Power, a chartered accountant and lecturer in accounting and finance at the London School of Economics, published an intriguing essay, entitled The Audit Explosion. Power argued that the growing multitude of audit procedures had changed the nature of service delivery. People and organisations that were consistently being audited – such as hospitals, schools, water companies, laboratories, and various industries – start thinking differently about their own activities; they start looking at their work from an auditor’s point of view. They focus on the measurable and quantifiable aspects of their work. Auditors generally do not see what is...

    • 5 When Ideologies Bounce Back The Problematic Translation of Post-Multicultural Ideologies and Policies into Professional Practices
      (pp. 64-78)
      Jan Willem Duyvendak and Justus Uitermark

      Since the days (1917) that Calvinists and Catholics were allowed to manage their own schools with full funding by the central government, Dutch society has valued the relative autonomy of ethnic and religious groups. The accommodation of immigrant cultures and religions fits with this picture, so it is not surprising that many commentators have labelled the Netherlands a multicultural society (Favell 1998; Joppke 2004; Koopmans & Statham 2000; Koopmans et al. 2005; Soysal 1994; De Zwart 2005). However, developments in recent years have cast doubts upon this image of the Netherlands as a ‘multicultural paradise’ (Duyvendak et al. 2005; Uitermark 2005)....


    • 6 Safe Neighbourhoods
      (pp. 81-96)
      Sophie Body-Gendrot

      Picture this: An elderly police inspector who knows the tricks of his trade. Serial killers, ordinary murderers, drug dealers, rapists, and thieves will no longer walk free as long as he is around to catch them. Accompanied by one or two faithful assistants, he visits crime scenes, interviews witnesses, looks for clues, studies his files, and hunts down the villains until they are safely behind bars. That is, if it is up to him, but usually it isn’t. The elderly police inspector whom we know from so many police series on television is very often pestered by the high and...

    • 7 When Diversity Matters
      (pp. 97-108)
      Marleen van der Haar

      Human service organisations are confronted with a culturally plural clientele. This study intends to unravel the everyday practices of social workers in dealing with cultural diversity. Assuming diversity has an impact on both the general repertoire and the everyday work of professionals, the question of this chapter is: How do professionals deal with diversity? I will focus mainly on what social workers experience in the providing of social services to a culturally diversified clientele: How do social workers talk about cultural diversity and how do they relate these issues to their professional attitude and competence in their own words?


    • 8 From Residents to Neighbours The Making of Active Citizens in Antwerp, Belgium
      (pp. 109-121)
      Maarten Loopmans

      In the 1990s, active citizenship and community involvement spread as core concepts in social policies across post-welfarist North-western Europe. Active citizenship has been promoted as an indispensable tool for the regulation of society, in policing and safety policies, provision of social services, welfare and health policies, and local economic development (Body-Gendrot 2003; Mayer 2003; Uitermark 2003; Cruikshank 1999; O’Malley & Palmer 1996; Rose 1996), but it has been particularly prominent in politics for the regeneration of – often urban – public space (Giddens 1998; Imrie 2004). These days, involvement, consultation, and participation are pervasive notions that emerge as a new specialisation...

    • 9 Authority, Trust, Knowledge and the Public Good in Disarray
      (pp. 122-134)
      Monique Kremer and Evelien Tonkens

      Over the last thirty years, welfare states have witnessed a considerable number of debates concerning the identity and power of clients of social and care services. Criticism of the authoritarian and paternalistic practices of professionals and a call for democratisation have stimulated changes in services delivery. Western countries have witnessed a trend towards more user-based services, with increased attention towards clients’ wishes and demands. The clients’ position towards services delivery has strengthened. This shift in power was initiated by the assumption of new roles as citizens and consumers. These roles were carved out against the older idea of clients as...


    • 10 Heroes of Health Care? Replacing the Medical Profession in the Policy Process in the UK
      (pp. 137-151)
      Celia Davies

      Not so long ago, a dozen or so people were gathered together at an invitation dinner hosted by one of Britain’s think tanks and health policy research funders. As the meal drew to a close, the host invited one of the academics present to open the discussion with some prepared remarks. A lively informal discussion ensued. Among those who had remained silent for a while was a senior doctor who had been invited to participate. His comments then became a point of reference for several others in the discussion. Not long after this event, I found myself at another dinner,...

    • 11 Tensions in Medical Work between Patients’ Interests and Administrative and Organisational Constraints
      (pp. 152-163)
      Werner Vogd

      The German health care system is undergoing various changes due to what is known as the third health care reform (Gesundheitsreform), initiated by the Social Democratic and Green Party coalition government. Obviously, one of the aims is to reduce the general cost of health services. With the slogan ‘Rationalisation without Rationing’ (Rationalisierung statt Rationierung), a transformation process is currently taking place which influences the work of medical personnel in different ways.

      This particularly affects hospital doctors, who will no longer be ‘captains of the ship’. New members of hospital boards will be increasingly recruited from the administrative elites. In this...

    • 12 Empowerment of Social Services Professionals Strategies for Professionalisation and Knowledge Development
      (pp. 164-180)
      Jeroen Gradener and Marcel Spierts

      Professionals in public service do not have it easy. They suffer under the constraints of government, market and managers, and are confronted with ever-higher demands that threaten their discretionary space. Freidson (2001) sees an advancing market logic in which citizens present themselves as vocal and demanding consumers who do not want to hear about the considerations and assessments that professionals normally make on the basis of their professional standards. Administrators, civil servants and managers are also constantly making higher demands on professionals that have little to do with the work itself. Standardisation and protocols resulting from this bureaucratic logic also...

    • 13 Professional Management of Professionals Hybrid Organisations and Professional Management in Care and Welfare
      (pp. 181-193)
      Mirko Noordegraaf

      Health care and welfare provision have always been complex phenomena – people who tend to be professionals who are caught between private situations, community interests and public values deliver soft services to vulnerable, weak, or powerless individuals. Over time, various types of governance have been introduced in order to organise and provide complex care and welfare. These governance systems have unavoidably been hybrid. Because health care and welfare are service delivery issues; because they involve vulnerable clients and professional providers; and because individual, community and collective interests collide – or conflict – it has proven difficult to leave care and...

  7. About the contributors
    (pp. 194-196)
  8. References
    (pp. 197-216)
  9. Index
    (pp. 217-221)