BBC Radio 4’s Analysis: War on the professions, broadcast on Thursday, 24th April 2008, discussed the various ways in which Government is seeking to regulate, and disempower, historically independent professions such as medicine, law and architecture. Is this because the professions are, in George Bernard Shaw’s words, ‘conspiracies against the laity’ i.e. organisations more concerned with protecting their own members’ interests than with serving society and/or consumers? Or is it because professionals view themselves, and are perceived by their clients, as practising in a space separate from, and perhaps morally superior to, the commercial marketplace? As Sunand Prasad, President of the Royal Institute of British Architects, puts it in the programme; “In order to be seen as a professional, you had to be seen to be above the marketplace. Notwithstanding that you create another marketplace, but there was if you like a marketplace associated in the popular imagination with venality, greed and self-interest and so on, which of course may well be the very things that drive the economy. But professions were definitely putting distance between that and themselves in order to be at the ruling table.”
But rather than a war between traditional Government and the traditional professions, I suspect that what we are seeing is the supplanting of traditional professionals by a new class of professional managers and regulators. In the process of establishing their hegemony, these ‘managerial professionals’ are engaged in breaking down the knowledge and skills of other professionals into information and standard operating procedures that can be exchanged, or traded as commodities, outside the privileged professional marketplace, thereby making them more accessible to consumers on the one hand and to corporations on the other. This new class is staking a claim to serve the public and/or consumers better than the traditional professions in the 21st century but, as Bernard Shaw might have observed if he were here to witness this process, the new managerial professionals may hide the ways in which they tend to operate against the public interest under the cloak of improving service to the consumer.
Sally Sheard, in a paper for History and Policy describes how the ‘government’s requirement for expert medical advice from the 1850s led to the development of a medical Civil Service, which reached its peak in size and authority in the 1970s.’ The paper traces the decline in the size and influence of this medical Civil Service and concludes with a warning that the government ‘needs to acknowledge that some of its tasks, such as protecting the public’s health, do not easily fit into fashionable Public Service Agreements or the ethos of New Public Management’
Scott Greer and Holly Jarman. in a paper for the Nuffield Trust show how the Department of Health was transformed, between 1983 and 2005, from a traditional Whitehall department into a ‘Department of the English NHS’. In the course of this transformation, medical civil servants, indeed nearly all ‘classic civil servants’ were displaced by a strong, professional managerial cadre, largely imported from the NHS.
In a BMJ editorial ‘What does the future hold for the NHS at 60?’(subs reqd) Rudolf Klein concludes that the ‘Department of Health is now dominated by former NHS managers who have brought with them a “can do” culture that has scant tolerance for the civil service tradition of putting policy proposals on the rack of analysis, examining inconsistencies, and identifying possible perverse outcomes. Analysis has too often been farmed out to management consultants who do not have to live with the consequences of their work. The civil service tradition was much derided by Margaret Thatcher and Tony Blair, who saw it as a recipe for delay and obstruction. But given the policy turmoil and fiascos of recent decades, the time may have come to revive it.’ BMJ 2008;337:a549
It would appear that, for the Department of Health, the war on the traditional professions began at home, and that traditional civil service and medical expertise within the Department has ceded the battlefield to a new professional class of regulators and managers. Whether these new professionals will act in the public interest more wisely or effectively than those they have displaced remains to be seen.
