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  • Author or Editor: Mike Saks x
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Unlike many other Western countries, Russia has never had an independent medical profession in classic neo-Weberian terms. Under the 1917 Provisional Government before the Russian Revolution, doctors came close to gaining an autonomous, self-regulating medical profession. However, the emerging profession was rapidly disestablished when the Bolsheviks came to power. This position was eased following the demise of socialism in Eastern Europe and the breakup of the USSR when a certain amount of reprofessionalisation began to take place as incipient independent professional bodies re-emerged in a more market-based economy. Despite this, they have yet to gain state underwriting as medicine has remained more a case of ‘professionalisation from above’ than ‘professionalisation from below’. This state autocracy stands in a long stream of Russian history, going back to the Tsars. It does not imply, however, that doctors have been uninfluential in Russia or that they have lacked regulation – it has simply not taken the same professional form as in countries like the United Kingdom and the United States. As this chapter underlines, the nature and implications of regulatory patterns in Russia remain very significant in terms of both physicians and the public alike.

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The Invisible Providers of Health Care
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Health care support workers (HSWs) play a fundamental role in international health care systems, and yet they remain largely invisible. Despite this, the number of HSWs is growing fast as governments strive to combat illness and address social care issues in a world of finite resources.

This original collection analyses the global experience of HSWs in the UK, Japan, Australia, Brazil, Canada, Portugal, Sweden and The Netherlands. Leading academics examine issues including the interface of HSWs with the health professions, regulatory practice risks, employment challenges and the dilemmas of an ageing population. Crucial future policy recommendations are also made for a world becoming increasingly dependent on HSWs.

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The introduction highlights the growing global importance of support workers and the need for further social scientific analysis of their developing role in relation to health professions, especially in neo-liberal societies. In so doing, it provides a brief overview of the constituent chapters of the book and how they hang together, including the neo-Weberian theoretical frame of reference. This overview underlines the need for further policy consideration internationally in this area, encompassing both the public and private sector as support workers are increasingly involved in health care, in association with professionalised groups such as doctors, midwives and nurses. In this light, the introduction asks what specific regulatory policy reforms might occur to provide a higher quality support worker labour force that will enhance the protection of clients and the public and foster positive work conditions in Western societies – based on an appropriate skill mix and interface with the health professions. In so doing, it builds on the empirical research on which this collection is based within the neo-Weberian theoretical framework that binds this book together.

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This chapter compares the marginal, but intersecting, groups of health support workers and practitioners of complementary and alternative medicine in the UK, with particular reference to changing national policy and workforce dynamics. It considers the background to each of these areas, as well as recent policies impacting upon them in more detail alongside the mainstream political, social and economic drivers of reform. This enables a number of comparisons to be drawn. In both cases the associated workforce dynamics have impacted on the healthcare division of labour, with differential moves towards professionalisation, which bring potential regulatory benefits as well as costs for the health workers concerned and the wider public.

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Following a neo-Weberian theoretical perspective, with reference to neo-Marxist analyses, this chapter considers the position of health support workers in the market in neo-liberal societies – with a particular focus empirically on a cross-country comparison between the United Kingdom and Canada. It discusses the role of health support workers holistically in the context of the wider range of health professionals with whom they work. Health professions themselves have been claimed in recent years to have been deprofessionalised or proletarianised. However, it is argued here that such trends are overstated and there is still typically a large gulf between the working conditions of this group of health professional occupations and those of health support workers. The latter are critically considered in terms of the recent interest in depicting such groups as the new precariat. It is argued that there is little doubt that in the United Kingdom and Canada most health support workers can be described as operating in precarious conditions. Nonetheless, doubts are raised as to whether this group will become the self-conscious and cohesive class as envisaged in neo-Marxist theory. The conclusion to the chapter highlights the policy implications of the analysis in light of current debates.

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The limited regulation of support workers as compared to health professional workers and the ensuing risks are discussed in this chapter from a neo-Weberian standpoint. It is argued from the example of the United Kingdom, and especially England, that it may be in the public interest, in terms of protecting users of services and their carers from harm, to extend the existing regulatory framework in a number of modern societies. This is particularly so at a time when health professions themselves are coming under increasing challenge in the wake of adverse events and the subsequent publicity to which they have been exposed. The range of actions taken to mitigate risk include extending state regulatory controls, establishing registers for additional occupations, increasing employer and professional managerial controls in the public and private sector, and implementing additional requirements for continuing educational development. Health support workers, who are numerically the largest group of health personnel, remain under regulated and under researched. Regulatory confusion too often prevails in the complex division of labour in health care in relation to the risks of support workers to users – not to mention vulnerable support workers themselves in terms of their precarious work conditions, as discussed elsewhere in this volume.

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International directions in healthcare
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This original and innovative book opens up new perspectives in health policy debate, examining the emerging international trends in the governance of health professions and the significance of national contexts for the changing health workforce.

In bringing together research from a wide range of continental European countries as well as the United Kingdom, Canada and Australia, the contributors highlight different arenas of governance, as well as the various players involved in the policy process. They expand the public debate on professional governance - hitherto mainly limited to medical self-regulation - to encompass a broad span of health care providers, from nurses and midwives to alternative therapists and health support workers.

The book provides new data and geopolitical perspectives in the debate over how to govern health care. It helps to better understand both the enabling conditions for, and the barriers to, making professionals more accountable to the interests of a changing public.

This book will be a valuable resource for students at an undergraduate and postgraduate level, particularly for health programmes, sociology of professions and comparative health policy, but also for academics, researchers and managers working in health care.

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This chapter pulls together the various threads of the collection by considering the future of health policy and workforce dynamics in rethinking professional governance in the international context. It begins by discussing the significance of the nation state as a navigator and the demand for institutional regulation across the various health professional groups, and how this is connected to new forms of professionalism. Then, it traces the translation of new forms of governance into professional development and the reconfiguration of boundaries, highlighting opportunities as well as new risks. It also considers the dynamics of de-regulation and the demands for re-regulation with regard to a mobile workforce, including different challenges, such as the gendered flexibilisation of work arrangements and migration tracks.

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Across many countries, professional governance is under the spotlight of health policy makers and subject to public debate. This book provides new data and geopolitical perspectives in the debate over how to govern healthcare. It sets out to highlight new international directions and the significance of national contexts for the changing health workforce based on complex sets of cultural and institutional regulatory patterns. One central goal of the new health policies that are emerging is accountability and control of professionals, which in turn calls for tighter regulation and new forms of professional development. This chapter describes the changing context of professional governance, researching the changing international governance in healthcare, new health policies remaking state-professions-citizens relationships, professional development and the structure of the book.

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This book opens up new perspectives in the health policy debate, examining the emerging international trends in the governance of health professions and the significance of national contexts for the changing health workforce. In bringing together research from a wide range of continental European countries as well as the United Kingdom, Canada and Australia, the chapters highlight different arenas of governance, as well as the various players involved in the policy process. They expand the public debate on professional governance — hitherto mainly limited to medical self-regulation — to encompass a broad span of health care providers, from nurses and midwives to alternative therapists and health support workers. The book provides new data and geopolitical perspectives in the debate over how to govern health care. It helps to better understand both the enabling conditions for, and the barriers to, making professionals more accountable to the interests of a changing public.

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