Professionalism, Boundaries and the Workplace

Edited by Nigel Malin, Routledge, £16.99

ISBN 0 415 19263 3

Professionalism is under threat, according to most of the authors of this clever compilation. The identified aggressors are managers, through a modernised artillery of control measures such as performance indicators, and consumers, who increasingly refuse to accept that professionals know best, a feeling fuelled by mass anger arising from cases and scenarios such as Waterhouse and Shipman.

Each chapter chronicles the demise of professionals against the inexorable rise of anti-professionals who have taken over the citadel. Examples are cited of clergy and church members, social workers and their clients, probation officers now being reinvented as outreach prison officers, and nurses forced to operate within a regime of emotion management, which calms people down as they wait for a service.

The result of this anti-professional behaviour is the deskilling of individuals and a short-cutting or "MacDonaldisation" of methods.

The book is not very strong on the relationship between professionalism and outcomes. With increased demands and cash limited budgets, care services must be highly efficient and well-organised as a set of public sector businesses in order to avoid excessive and "uncaring" waiting lists.

Professionalism in itself does not guarantee good outcomes for service users, hence the need to adopt evidence-based approaches. Autonomous decision-making by GPs and other professionals has been shown up by audits and inquiries into clinical and professional practice to be insufficiently skilled to be relied upon without more checks and balances and a greater accountability.

The book explains how part-time staff, agency staff and outsourced services can all weaken the culture of organisations and fragment the boundary between organisations and the people they serve. This is highlighted by well-argued contributions from a diverse group of lecturers and researchers, although the book could have benefited from a stronger set of perspectives from users and carers.

Vulnerable people are under threat if the professional staff providing frontline services to them feel their value base is being undermined and if they experience the demands of their administrative bureaucracy as overwhelming. This book will help students to chart and understand the complex changes taking place in contemporary social organisations, changes which are accelerating relentlessly.

Anthony Douglas is executive director of community services, London Borough of Havering