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fabian tract 473 
socialism and 
professionalism 

chapter 
1 introduction 1 
2 the profess·ions and s·ocial welfare 3 
3 the current critique of the 

professions 10 
4 towards a policy for the professions 17 
5 the strategy for a new relationship 19 

the author: 

Paul Wilding is currently Senior 'Lecturer in Social Administration 
at University ·College, Cardiff. In September .1981 he will become 
Professor of Social Administration at the University of Manchester. 
His book "Professional Power and Social Welfare" 
will be published by :Routledge and Kegan Paul later this year. 

this pamphlet, like all publications of the Fabian Society. 
represents not the collective view of the Society but only the 
views of the individual who prepared it. The responsibility of 
the Society is limited to approving publications it issues 
as worthy of consideration within the Labour movement. 
Fabian Society, 11 Dartmouth Street, London SW1 H 9BN. 

1

March 1981 ISSN 0307 7535 ISBN 7163 0473 2 


1. introduction 
Socialists have never :been a·ble to make 
up their minds a:bout ,the professions. 
Some commentators have seen the 
ration<!!l, scientific approach to deallingwith social pw'blems and human needs 
as a stage on the road to socialism. Other 
socialists ha·ve seen the professions as 
the allies and servants of an economic 
and social system hosti1e to socialism, 
and so as obs,tacles 'to be overcome. 

Jn fact, histor.ic differences in socialist 
philosophy lead to quite different attitudes 
to the professions ·and these differingtraditions are refi.ected ,in contemporaryuncertainties. G D H Colle and .the W ebbs 
can serve as representatives· of Vhe two 
strands of thinking. " He still conceives 
the mass of men ", Cole wrote of Sidney 
.We!Jb in 1918, "as persons who ought 
to 'be decently treated, not a's persons.who ought freely to or.ganise their own 
conditions of life; in short, his conception 
of a new social order is stil'l that 
of an order that is orda·ined from without, 
and not realised :from wi.thin " (A W 
.W11i:ght, G D H Cole and Socialist 
Democracy, Garendon Press, 1979). 
Cole's socialism 'was quite different. lt 
was 'a socialism realised ,from wi·thin not 
ordained .from without and the crucial 
factor in its achievement was the more 
equa'l distribution of power in society.
ln Co'le's view, says Wright, " the character 
o:f human rela:tionships was seen 
as the product of the nature of P'OWer 
.jn society, polity and economy. Was ,uhe 
exercise 'Of power democratic or autocratic? 
W'as .jt remo'te or accessible? Was 
democracy nar.rowly pohtical or genuinelysocial? Was it unitary or functional ? 
;fhe answer to these questions were consistently 
·regarded 'bY Cole as the keydeterminants of ·Vhe character of s-oc1al 
relationships. They wou'ld determine 
whether there was s-olidarity or division, 
.wining service or compulsory labour, 
.vitality or sterility, cooperation or com


petiti·on, freedom or servility, distrust or 
fellowship " {ibid). 

There has been little real attempt to 
think thmugh the ro'le of the professions 
in a socia·lis't society or, more immediately, 
to work out a po'i•icy for the professions 
whidh should be pursued by a 

Labour government under wel.fare 
capita:lism. 

This pamphlet seeks to open ,for debate 
and discussj.on the role ·Of certain of the 
key pro:fessj.ons in our social welfare 
system where the issues of the publicaccounta!bility and con'Urol of the professions 
are perhaps most olbv·i'ous. The 
prob'lems posed :by different professions 
do vary •Con1Sider3!b1y but t his pamphlet 
will discuss them a:t a gener.all 'level ; 
since 1he li·ssues are sufficiently similar to 
make genera-l dis·cussion: the !best wayof proceeding. The discussion is in three 
pa:rts. Chapter 2 looks alt the posiltli-on of 
the chosen pr.cifes·sions in our socia!l welfare 
syS'tem and the power they exercise. 
Chapter 3 looks ·a:t the current critique of 
the professions which has developed in 
recent yea•rs. Chaplter 4 outlines t he basis 
o'f a soci-~list .pobicy f.or the professions 
and suggeSts some .of the measures which 
need to be adOpted if the prdfessions are 
to <l!ssume a more acceptable role in 
society . 

The discussion concentrates on .the professions 
and would-be professions whose 
mle in the social welfare services is most 
obvious-doctors, teachers, sociai workers 
and town p'lanners. Other groups cer'
tainly have ·a cla·im to lbe included·
accountants, lawyers, ardhitects and sur-
IVeyors for example--as they exercise 
,con\5iderable power, 'but the concentration 
here is on those prolfessions most 
·olbviously and directly involved in the 
delivery of socia:l services. 

!Another problem .for anyone seeking to 
·explore the iposit•ion of the professions 
un modern society is ·the unbalanced 
nature oif the available 'literature. Much 
more has been written about 1the medical 
!Profession than 1about the ovher professions 
and any discussion tends to be 
medically dominated. This pa:mph1let tries 
.to avoid !this difficul,ty but without aHolgether 
succeeding. The argument for a 
,general discussion even though the 
medical profession provides an ex·cess!'Ve 
·number of examples and illustrations is 
tha,t medicine provides ·a model which 
'Other professions 'aspire to emulate . . If 
that ·is what pwfessionalism is rea'lly d1ke 


lin the eyes of other aspirant and strugg-
Jing professional groups, then paying 
more attention to medicine can be justified 
as illustrating .prdblems likely :to arise 
jf other professional •g.roups ·are allowed 
to develop as they wish. 


2. the professions and 
social welfare 


The centra:! issue raised lby an examination 
of the position of what may usefully 
be called ·the welfare professionalsdoctol\
S, social :Wol'kers, .teachers, town 
planners-is the power they wield. As 
'government responsilbilities ha,ve ex· 
IPanded, its dependence on experts and 
professionals has .jnoreased. Public 
acceptance of the legitimacy of the power 
and influence of the professions owes 
LSornething ~to a gener.a:l i{aith in expertsand something to the way in which such 
!POwer and influence are accepted by!government. There is room for debate 
about the reasons for the rise of the 
!Professional es·tate, less alboll!t the fact 
tthat the prafessions have now in many 
~mportant areas become wha,t Titmuss 
called "the aorbiters df our welfare fate". 
For democrats and socialists, the key:issues revolve round the legitimacy of 
such .power, the use to •which it is put

and its impact on our social welfare 

• system. 
lfhe power of the professions can usefully 
be considered under five headings 
~power in policy making and a·dminis· 
'trati·on, power !to define needs and problems, 
power in resource a:llocation, power 
over peop'le, and power to control their 
a•rea of work. This chapter will explore 
the exltent ·of professional power in each 
particutar area and Why <it is problema!t'ic. 

power in policy making 
and admini'wation 


lfhere is a mass of evidence albout the 
.enormous influence which the professionsexerci·se in policy making and the administration 
O'f •social services. The most 
.Obvious example of such influence ·is the 
role of the medical profession in relation 
to health policy and the administration 
of the National Healfu Service. "The 
history of the 'British health service", 
says Rudolf Klein, "is the history of 
'P'Ol,itiioal power, ministers, civil servants, 
Parliament, accommodating itself to professiona:
l power" (R Klein, ComplaintsAgainst Doctors, Charles Knight, 1973). 
All the major changes in the organisa:Hon 
of hea:lfu services this century-1911, 
~946 and 1972_-.;bear witness to the enor


mous .power and influence of the medical 
profession, 'both to control the :terms of 
debate, to lay down the parameters m 
the .possible and, in the end, to ensure 
that any changes .take full account of the 
profession's demands and interests. 

Speaking of the reorganisation of ·the 
National Health Service whidh was 
effected in 1974, R G S Brown describes 
the new structure as "modelled .to the 
desires of the medica! profession " (R G S 
.Brown et al, New Bottles Old Wine, 
University of Hu'll, 1975). But ll'pparently 
enough was not enough for the medical 
profession and it successfully persuaded 
the Conservabve •government of 1979 of 

•the need to simplify the professionaladvisory machinery in the NHS " so that 
the views of clinical doctors, nurses and 
of the other .professionals wiU be better 
heard by the hea~th authorities" '(Patients 
First, HMSO, 1979) . 
Do other prafessions have a comparably 
.commanding position in policy making? 
Teachers lack the standing and status of 
doctors. They have been "less successful 
·in asserting their special role as generalised 
wise men vis a vis anything re· 
motely to do with education, but their 
role in educational policy making is 
centra:l. Maurice Kogan describes the 
.teachers' associations as " only a wafer 
away from the Local Authority Associations 
in consultative staJtus " (M Kogan, 
<Educational Policy Making, AUen ·and 
Unwin, 1975). The profession has successfully 
opposed the use of auxiliary teachers 
~n the classroom. It persuaded Edward 
Short when he was Secretary of State 
to end the .right df unqualffi·ed staff to 
teach. It has .been a force for the aJbolition 
of selection for secondary education . 

,what of the influence of soci.a:J. workers? 
Two pieces of recent legislation show 
the importance of social work influences 
on po1icy making-the Children and 
:Young Persons A at 1969 and the Local 
Authority Social Services Act 1'970. The 
1969 Act l'>hows jn substantial measure 
.the triumph of social work definitions of 
the problem of delinquency and marks. a 
si'gnificant transfer of power from magJstraJtes 
to ~he professionals. It is a tribute 


to the power and influence of social 
.workers that the Seebohm COiffimittee 
was s·et up in 1965 to review the structure 
and responsihihties df the personal social 
services. The composition of the Com· 
mittee is a ,further comment on the 
success of the social work world in persuading 
the authorities that ~the issues 
were such that soci·al work representatives 
should predominate on the Committee. 
When 'the Committee reported, 
the Calbinet's initial reaction was that it 
was, in Q .ossman's words, "a contemptible 
repo.rt ". Social •work influence was 
a ma:jor factor in 1the 'way in which the 
report was nevertheless translated into 
the !Local Authority Social Sei"Vices Act 
1970. 

.What is the significance of professional 
power in policy making and administra· 
tion? Fi~tly, professional influence means 
that on many issues -the decisions which 
are made serve professional interests 
rather than the public interest. Secondly, 
it 1eads to services organised according 
to professional skills and ideas rather 
than according to client needs. Thirdly. 
it means that certain elements and 
interests rwithin the professions are able 
<to dominate decision making because of 
thei·r greater prestige and status. 

It is not difficult to find evidence fo.r the 
first point. It is ,the determination of the 
medical profession to preserve the independent 
contractor position of the GP 
which has prevented the developmentof an integrated health service-and lfrom 
that failure many of the most vulnerable 
g·roups in society continue to suffer. At 
the 1evel of District Planning in the NHS 
the medical profession has an effeotive 
veto over developments it does not like. 
Things can only get done with prcYf_essional 
approval. The fact that areas which 
were short of doctors in 1948 are still 
relatively short today is a tribute to the 
power of the medical profession . to yrevent 
a rational policy for the distnbuttion 
of professional staff. On the baSIS 
of a narrow prdfessionalism, teachers 
have successfully opposed any moves bythe Department of Education and Science 
for increased parental participation in 
pre-school education. Sinfield's comment 

on the Setfuolm report aptly capturesthe signifiance of social work ·influence 
on its proposals----.and so on the l-egislation 
·which carried them into effect. "A 
ci·tizen ·reading the report " 'he wrote. 
"might indeed conclude that it had more 
to do rwith the work satisfaction and 
career structure of the professional socia'l 
.worker than i•t had to do with his own 
needs or rights in the modern welfare 
state " (A Sinifield, Which Way for Socia/ 
Work?, Fabian Sooi~y, 1969). 

The second criticism that professionalinfluence ·leads to ser·vices organisedaccording to professional skills rather 
than client needs is equally easy to support. 
On many occasions Crossman 
attacked the move in the 1960s to Jarge 
District General Hospita'ls as beingprimarily for the conv·enience of the consultants. 
The convenience of the consultant, 
Crossman pointed aut, was givenvery high priority ; the convenience 'Of the 
patient and the !family who wished to 
visit him a very low priority (R H S 
Crossman, A Politician's View of Health 
Service Planning, Universi-ty of Glasgow, 
1972). 

Again, one of the most damaging divi· 
sions in our social 1welfare system is the 
division of ·responsi·bility !between heal,th 
and persona'! social services-a division 
which for many needs groups is arbitra·ryand iJ.logical. It is -the dir·ect result of the 
relevant professional groups insisting that 
services be organised around their skills 
rather than around patient needs. 

The third indictment of professionalinfluence is -t'hat it gi·ves certain profes·
sional elites a dominant position so lead· 
ing to biased, unbalanced developmentwithin services. Hospi.ta'l medicine dominates 
the NHS because hospitals, ·according 
to dominant professional ideologies. 
are where real medicine is ca·rried on. 
Within hospitals the stress has been on 
high technology medicine rather ·than on 
caring services-lbecause caring is a low 
status activity within the medical pecking 
order. It is clear ·rhat the influence of 
the medical profession, and <particularly 
that of consultants in prestigiouspeciali•sms has he1ped perpetuate cin



dereHa sections in the NHS. 

The same charges can be laid againstsocial workers. They have effectivelydominated discussion about the development 
of personal social services havingpersuaded the policy makers that theirs 
is, in some way, the vital role. One 
important result has been that little 
thought has :been given to the role, .func· 
tion and training of other kinds of 
auxiliary and anci1lary staff. Professional 
influence has narrowed thinking about 
the development of social care services. 

The purpose of this section has been to 
raise the issue of the nature and extent 
and importance of professional powerand influence in policy making. The 
argument has been that such influence 
is to be regarded as problematic. Pro.
fessionrul influence rand advice is interested 
rather than by definition altruistic and 
objective. It needs critical evaluation. 

power to define needs 
and problems 

A crucial element in the power and 
influence of the professions in policy 
making and administration is acceptanceof professional definitions of needs and 
problems. Professions, it is assumed, 
know aJbout these things. Their definitions 
are scientific, objective, expert and 
relia!ble. 

Until very recently the medical profession 
successfully defined health in terms of 
helrlth services. Health services were the 
crucial element in the maintenance of 
health-or so it was asserted and believed. 
Increasingly, that professional definition 
is being challenged as the importanceof way-of-life factors is reasserted. Again, 
until recently the medical profession'sdefinition of the needs and problems of 
the mental'ly handicapped was acceptedwithout question. Now, increasing numbers 
of eXJpents would accept the partial 
nature of that definition and would agree 
that its effects on policy have been 
damaging. 

Another influenti,al problem definition 
which expresses no more than a half 

truth is that the central problem of the 
National Health Service is one of shortage 
of ·resources. That is the definition 
which the medical profession has successful'ly 
propagated-so divesting itself of 
all blame for the shortcomings of the 
service. The central issues of clinical 
freedom .and how resources are actuallyused remain safely off the agenda. 

In the field of housing and town planning 
the definitions of the professionals rather 
than the definitions of those who live in 
houses asserted to 'be unfit have carried 
the day. A mass of evidence now exists 
to show the gap 'between consumer and 
professional definitions but the powerwhich accrues to the professionals-
environmental health officers and town 
planners-from the supposed scientific, 
professional nature of their definitions is 
immense. Thousands of people who were 
quite happy with their housing have lost 
it and :been forced to move because of 
the professionals' power to define their 
housing as unfit. 

There are, in essence, three reasons whythe professional power to define needs 
and problems is problematic. Firstly, the 
professional's view of the world is 
narrow. Definitions of problems tend to 

be in individual rather than in structural 
terms, they tend to he in terms which 
bring the problems within the legitimate 
bounds of professional concerns-alcoholism 
and addictian come to 'be defined 
as diseases, pregnancy as illness, delinquency 
as maladjustment~and these 
definitions become enshrined in policy.
The structural, political nature of problems 
is overlooked because that placesthem beyond the bounds o.f even the most 
imperialist professional's concerns. 

The second reason for anxiety is that 
when professional definitions carry the 
day, the client view is likely to be neglected 
or ignored. Without such a perspective 
the " problem " at issue is 
unlikely to 'be adequately grasped or 
effectively tackled. The reality of the 
situation as it appears to the client must 
be the starting point for any successful 
attack on the problems posed by, for 
example, the presence of a mentally 


handicapped child in the family, byphysical handicap or delinquency. Professional 
definitions, because of a spurious 
confidence in professional expertise and 
its objectivity, tend to ignore client and 
consumer views. 

The third dbjection to the influence of 
professional definitions of needs and problems 
is that such definitions are partialand partisan. As Eliot Friedson puts it, 
"Consulting the profession the state 
obtains not on1y expert opinion on how 
to serve the needs 1he •public peoceives 
but als·o partisan opi•ni'On about what the 
public's needs actuaLly a·re irrespectiveof lay .opini·on " (E Friedson, Profession 
of Medicine, Dodd Mead, 1970). 

power in resource allocation 

Professional power in resource a'llocation 
is ·of various kinds. There is the influence 
which professionals exert over decisions 
about resource allocation by central and 
local government. There is also the power 
and influence exerted at the organisational 
level when professionals make decisions 
albout resource us·e. Finally, there is the 
point at which individual professionals 
meet individual clients and allocate or 
refuse them resources of various kinds. 
At all three levels, professional power in 
resource use is substantial! and is often 
exercised .with few polibica~ or bureaucratic 
constraints. 

The way the hospital sector has increased 
its share of NHS resources since 1948 is 
a tribute to the power and influence of 
the medical profession at the level of 
central government pl•anning. Crossman's 
attempt to shift resources towards services 
for the mentally handicapped called forth 
a memorandum f.rom the Chief Medical 
Officer saying such a proposal would 
lead to a major row with the consultants 
{R H S Crossman, The Diaries of a 
Cabinet Minister, Vol. III, Hamish Hamilton 
and Jonathan Cape, 1977). Little 
therefore came of it. 

In the NHS, as Brown points out, it is 
the doctors' decisions which "effectively 

commit most of a health authority'sresources " (R G S Brown, Reorganisingthe NHS, BlackweLl and Mar·bin R•obertson, 
1979). The Department of Health 
and Social Security takes the view that 
" doctors and other professional providers 
~ services have individual professional 
!freedom to do what they consider 
to be right for their patients. Thus, 
in each individual doctor-patient situation, 
it is the doctor who decides on the 
appropri•ate priority" (quoted in R Klein, 
"The Doctor's Dilemma for Accounta


bility", Public Administration Bulletin, 
No 17, 1974). 

The doctor's clinical freedom gives him 
the right to prescribe whatever treatment 
he considers appropriate with only mini· 
mal checks. Checks on the prescribingpractices of the GP are no more than 
residu•al; on the prescribing pattern of 
hospital doctors they are non-existent. 
The very great variations between the 
length of hospital stays for similar complaints 
in different hospitals shows the 
independence of consultants in the use 
of hospital resources. The consu'ltant 
decides what is appropriate-whateverresearch findings may show about optimum 
len-gths of hospital stay or the 
inefficacy of treatments. 

Little is known about how resources are 
used in schools but it is clear that the 
head teacher has the power to make 
decisions, largely about staffing resources, 
which can be of substantial importance 
to the lives of the pupils. There can be 
smaller teaching groups ifor less able 
children or a wider range ~ options in 
the sixth form, .for example. The more 
experienced, a~bler teachers can be allocated 
to the abler or less able children. 
It is almost impossible for anyone from 
outside to cha1lenge these importantdecisions about resource allocation within 
the school. 

Social workers, like doctors, have considerable 
freedom in how they use the 
important resource of their own time. 
Their decisions can also commit substantial 
amounts of departmental re· 
sources. How social workers interpreta care order may commit many thousands 


of pounds over many years-and it is a 
professional decision. 

The only financial resources which social 
workers control directly are those payments 
they can make under Section I of 
the Children and Young Persons Act 
1963. The total sum involved is small-
though often crucial to the survival and 
well •being of a family. Research on social 
workers' power in this area makes it 
pfain that the matter is regarded as a 
pure'Iy professional one. Details of t'he 
criteria for granting aid are never published 
so that clients can see them. There 
is no appeals system irf aid is refused. 
The social workers' decisions are final. 

There are at least four ways in which 
professional power in resource allocation 
is questionable. Firstly, whatever the 
supposed priorities of governments, the 
professionals are C!!ble substantially to 
determine how a service operates. Official 
priorities-in favour, for example, o.f 
cinderella groups in the NHs-can be 
negated by professional power over resource 
use. To a democrat that is 
intoler<11ble. 

Secondly, it means that ·resources can be 
deployed for professional convenience 
rather than to meet client need. There 
is considera:ble evidence, .for example,
that recent trends and deveopments in 
how resources are used in genera'! practice-
appointments systems, development 
of group practices, the decline in home 
visits, the eXIpansion in the use of deputising 
services at evenings and weekends 
-have been rfor the benefit and convenience 
of doctors rather than patients. 
There is, however, little opportunity •for 
anyone to challenge such behaviour. 

Thirdly, professional control over resources 
negates planning and management. 
The attempt to use resources for 
maximum efficiency and effectiveness can 
be negated by professionals refusing to 
modify their practices-over length of 
hospita'l stays for example. 

Fourthly, professional control of resources 
usurps the a,ppropriate sphere of 
political decision making. Professional 

control may be appropriate when decisions 
are essentially expert and technical 
but it cannot be justified when the 
decisions to be made are political and 
involve the distribution and redistrilbution 
of goods, services and opportunities between 
individuals, groups and classes. 
Town planners have secured and maintained 
considerable control over spatial 
resources through arguing that the 
decisions to 'be made were essentiallytechnical. To anyone other than a planner, 
the scope and significance of such decisions 
and the number of people affected 
make them clea·rly political. 

power over people 

Power in policy making and administration, 
power to define needs and problems 
and power in resource allocation is, of 
course, indirectly power over people but 
many professionals also wield more direct 
power of this kind. Generally it is power 
over the sick, deviant and delinquentand over those who, for other reasons, 
come within the purview of the social 
welfare system. Clearly someone has to 
make decisions on issues such as compulsory 
admissions to mental hospitals 
and on whether delinquents and criminals 
should, or should not, be committed to 
penal institutions and for how long. In 
the past such decisions have generallybeen regarded as matters of law to be 
judged by the courts on the basis of 
custom, common sense, instinct or 
experience. Increasingly the idea that 
ther·e is an expertise on matters has been 
accepted and important powers have been 
passed to the professional •groups claiming 
that theirs is the expertise. The powers 
are frequently very considerable and the 
safeguards Which surround their ex·ercise 
are normally extremely limited. 

The Mental Health Act 1959, for 
example, made the decision ·about compulsory 
admissions to menta'! hospitala purely professional one. The role of the 
courts came to an end. Doctors assumed 
the major responsibility for the exercise 
of this daunting power. 

There is no right of appeal for any patient 


prior to admission, or .for patientsadmitted under short term compulsoryorders for 28 days or less. The Mental 
Health Act does not define many of the 
key terms it uses-mental illness, for 
example-so enormous discretion is left 
in t'he hands of the doctors and social 
workers who operate the Act. To all 
intents and purposes there is just no 
machinery for reviewing the decision to 
admit a patient compulsorily-only for 
deciding an applicant's fitness for dischal'ge 
at the time of the review-and 
the position of professionals in the review 
system is open to a number of criticisms 
( cf P W H Fennell, " The Mental Health 
Review Tribunal: A Question of lm· 
balance", British Journal of Law and 

Society, 1977). 

The other most significant transfer of 
power from the courts to professionalsin recent years is that enacted in the 
Children and Young Persons Act 1969. 
The power of the social worker is greatestwhen the court makes a care order committing 
the child to the care of the local 
a:uthority. It is the social workers who 
decide what such an order shall mean-
return home for the child or commitment 
to a secure institution or something 
in between. The decisions are made behind 
closed doors ; they are subject to 
few, if ·any, checks or slllfeguards. 

Such powers assume the existence of the 
expertise to make decisions of this kind 
about how to change delinquents into law 
a!biding citizens-and it assumes social 
workers possess it. 11here is no evidence 
for either of these assumptions. Power 
was granted on the basis of assumptions 
which were incorrect. The legitimacy of 
such extensive powers, and the absence 
of effective .rights cYf appeal gives cause 
for consideraJble anxiety. 

Teachers, too, have great power over 
those they teach, power to order their 
lives in the present and to influence them 
for the future--and it is an exercise of 
power which parents or lay politicians 
have very little a!bility to question or 
alter. Inevitably, if not deliberately,
teachers label and categorise pupils-andthi·s can produce the kind of subcultural 

attitudes and values descritbed so vividlyby David Hargreaves in Social Relations 
in a Secondary School (RKP, 1967). The 
differences he depicts between the A and 
B streams and the c and D streams witness 
to the power of teachers over pupils. 
Teachers can also deliberately ·set out to 
inculcate particular patterns of attitudes 
-to authority, competition, cooperation, 
racia1 and sexual differences. 

Clearly there are a·reas and issues in 
individual and social life where expertshave to decide what action is needed, and 
to take it. What is worrying is when such 
power extends beyond the area of e~pertise 
to areas which are essentially suitable 
only for lay and political judgments-
and many of the powers which professionals 
exercise over people are wide open 
to this cha·rge. 

power over area of work 

AU professional groups aspire to control 
their own area of work-to regulate the 
behaviour of their members, to set standards 
of entry to the profession, to controi 
training, to enforce a pr.ofessionalmonopoly, to control the number of 
entrants to the profession. Different professions 
ha·ve secured such power·s in 
varying degrees. 

It is, of course, part of the professional 
case to suggest that the granting of such 
powers is an unmixed benefit to clients. 
That claim needs examination. All occupational 
groups are interested parties. 

They have at least half an eye on the 
interests of their members as wel'l as their 
clients. Claims for longer training and 
for an all-·trained service may !be for the 
public good, but such claims are also 
part of the professional .gospel of self 
importance. Lengthy training may tbenefit 
clients, but it is also, in a credentia'listdrunk 
world, a public statement of occupational 
importance. 

P·rofessional control of entry to the 
medical profession is problematic in a 
number of ways. It means, so it seems, 
a social class distribution of entrants 


heavily biased in favour of social classes 
1 and n which is one factor in the subsequent 
geographical maldistribution of 
doctors. The stress on the need for high 
intellectual ability to become a doctor 
has also, Horwbin argues, helped to bias 
the development of medicine in favour 
of technology :rather than basic caring(D F Horrobin, Medical Hubris, 
Churchill Livingstone, 1978). 

Furthermore, professional control of 
medica1 training continues to mean a 
pattern which reflects the high prestige 
sectors of medicine rather than the main 
emerging health p·rolblems of today. If 
the largest and most formidable problems 
which medicine now faces-mental illness, 
geriatric medicine, physical handicap and 
chroni·c illness-are excluded from the 
work of most teaching hospitals, then 
the doctors of the future emerge with a 
strange view ·orf .what medicine is really 

•a!bou:t--'and ilil equipped to pmctise it. 
A professional monopoly, which is the 
goat of ·aH self-respecting aspirant professions, 
is less than pure gain for the 
rest of society and is a useful example 
of the dubious effects of professional 
power to control the area of work. What 
is quite clear is that much of the work 
done by doctors, teachers and social 
workers does not require their lengthytraining, professional skills or substantial 
salaries. A considera!ble proportion o.f the 
cases dealt with •by a OP could be dealt 
with very competently by a trained nurse. 
Equally, lengthy training is not required 
for significant parts of the work which 
social workers undertake. A:!! professionals, 
however, a.re relucant to acceptthe help of aides and a:uxilia·ries for fear 
of compromising their own position. The 
result is that scarce and expensive pro· 
fessional time is wasted on work which 
does not require professional skills. 

Another disa:dvantage lies in the standard 
of service offered by people who are 
overtrained and overskilled for what they 
are tackling. GPs and social workers are 
united in one thing if in little else, and 
that is the continuous chorus of complaint 
they pour out a~bout the trivial problems 
with which they are inundated. Such 

supposedly trivial issues might well getcloser attention f.rom a less trained 
person. Those g-roups such ·as the elderly, 
who are not popular with social workers, 
might well get a better service from 
workers selected for their interest in old 
people and then given a specific training. 

conclusion 

An understanding of the weLfare professions 
depends fi·rst of all on graspingthe centra'! elements in their position in 
the operation of social welfare services. 
This is that the central element is ·the 
power they wield-in policy makingand adminisltration, in the defin'ition 
of needs and pmblems, ttn resource 
allocation, over people and in the control 
of their a.rea of work. That power has 
developed without any considered decision 
by governments or any thoughtof its significance or implications. What 
has evolved is a sHuation which is clearlyextremely dubious .for anyone concerned 
for democracy, individual rights, efficiency 
and equity in our social welfare 
services, or for anyone alert to the position 
of many of the most vulnera!ble and 
disadvantaged groups in society. 


3. the current critique of 
the professions 
In recent years there has been considerable 
critical discussion of the role of the 
professions in society generally and, more 
particularly, of their role in the social 
welfare system. To understand the professions, 
and therefore as a necessaryprelude to developing a socialist policy. 
we need to be aware of the nature of 
that critique. 

claims and achievements 

At the heart of the critique has 'been a 
re-evaluation of the claims and achievements 
of the professional groups we have 
been considering-doctors, teachers, 

ocial workers and planners. Were their 
claims to expertise and to the ability to 
deliver good health, education, individual 
and community well being justified? In 
the light of the critique-from both 
inside -and outside the professions-theprofessional claims emerge rather bruised 
and the achievements appear as rather 
less conspicuous than might perhaps have 
been expected. 

Medicine has generated its own internal 
review. The verdict of one of its most 
distinguished critics, Professor Thomas 
McKeown, is that "At all stages of 
history doctors have overestimated the 
results of their intervention" (0Mclachlan and T McKeown (eds), M edical 
History and Medical Care, CUP, 1971). 
What is increasingly clear is that health 
services are not a key determinant of 
health-and in the past it has generall y 
and easily been assumed that they were. 
This has contributed to the medical profession's 
prestige. National, regional, sex 
and class differences in the incidence of 
heart disease and cancer, for example, 
suggest that the causes are ultimatelv 
environmental, that the roots lie in 
particular ways of life. If that i so. the 
role of medicine becomes les ignificant. 

Evidence about varied and incon istent 

diagnosis by doctor , unnece ary and 

over long ho pitalis-ation, wide variation 

in ho pita! tay for imilar conditions 

and the continued use of treatments 

hown to be ineffective, all uggest that 

individual idiosyncratic judgments play 
a large part in what is supposedly scientific 
medicine. Such findings have helpedweaken the standing of medicine in 
society. The development of a termiatrogenic 
disease-to describe the ills 
produced 'by medical intervention suggests 
a new realisation that the results of 
modern medicine are not always benign. 

Social workers are open to the same 
attack of high claims and limited achievements. 
They may not he solely or even 
mainly to blame for the succession of 
child care tragedies of recent years but 
most of the subsequent enquiries have 
produced critical comments on the roles 
played-or not played-by the social 
workers involved. In the field of mental 
health and compulsory admissions to 
mental hospitals, research shows ocial 
workers to be ill equipped by training 
or experien{;e, lacking, as one authoritative 
investigation puts it "expertisewhich qualifies them to do anythingexcept the most simple and basic tasks 
in the compulsory admission procedures"
(P Bean, Compulsory Admissions to 
Mental Hospital, John Wiley, 1980). 

At issue with social work, as with medi cine, 
is the validity and reliability of the 
knowledge base which is claimed. I there 
really a reliable corpus of knowledgeabout individual and social functioningwhich provides a solid base for ocial 
work intervention on lines of provenefficacy? There is no doubt that social 
workers help a 'lot of peopile; that is not 
the issue. The 'issue is the extent to which 
such giving of help is based on more than 
informed intuition, experience of the 
world, sympathy and common sense. 

It i unnecessary to labour the point. In 
the past, the claims of the welfare professions 
to knowledge and expertise were 
accepted and not questioned. Today they 
are much more regarded as up for testing. 
Question about the knowledge base and 
the expertise of occupational group doctors, 
social workers, planner , teacher 
-leads to a que tioning of the powersand privileges which have been justified 
in terms of uch experti e. An important 


brick in the base of the professionaledifice has been loosened. 

failures of resp·onsibility 

The professions have also come under 
attack in recent years for alleged failures 
of professional responsibility, that is for 
failure to pursue their work in waysjudged by their critics to be fully professional. 


There have :been the scandals concerned 
with the running of long stay institutions 
for the mentally handica~pped and scan· 
dai-s to do with tJhe deaths of children 
for whom the local authority was respon· 
sible. What is striking and extremelydisturbing is :that conditions in long stay 
hospitals-Ely, Farleig'h, Normansfiel<i 
and the rest--were only revealed as the 
result of scandals. The medical prO'fession 
played no part in bringing such shocking 
conditions to public notice. Those respon· 
s~ble .failed to assume the responsibility to 
eXJpose their condi·tions of work and to 
press in every possible way for the 
resources required to deliver a profes·
sionahly acoceptruble sefVlice to the public. 

In ·fact none of the great social welfare 
scandal:s of the 1960s--->Conditions in 
long stay hospitals, the rediscovery of 
poverty, conditions in old people's homes, 
homelessness, the slum school-were 
publicised by the ·respOJ?-Sible profes·
sionals, a shameful fa1lure m professJOnal 
responsibility. 

In the child care scandals, what came out 
of many of the inquiries was t~at well 
intentioned pmfessionals failed m some 
way or other, even if [or valid reasons, 
effectively to oarry out t~e1r profe_s~10nal 
responsi•bilities. They fa1led . to VISit, to 
liaise to coordinate ; they fa1led to assert 
their' rights and responsibilities in wayswhich might have better protected those 
for whom they were responsible. 

Another .failure in responsibility with 
which all professions can be charged IS 
failure to evaluate their knowledge base 
and the effects of professional action. 
"We do not know", Horrobin •Wrote in 

a spasm of professional f·rankness about 
medicine, " whether most of the thingswhich we do to patients are !better for 
the welfare of that patient than i.f we 
had done nothing at all. And on the 
whole most of us prefer to remain 
warmly ignorant rather than coldly knowledgeable 
about the situation" {D F 
Horrobin, Medical Hubris, op cit). That 
is true of al'! professions. Doctors, planners, 
teachers and social workers have 
all failed-or refused-to monitor the 
results of their activities in a way which 
is quite unacceptable in groups claiming 
a scientific base for their work. 

A further charge of a di'fferent kind of 
failure of responsibility to which most 
professions are open, is that of a se~f 
centred focus in ·their work. Services 
or.ganised around professional skills show 
the power and influence of profess!ona1s 
in policy making and they also <i1splay 
a failure to see things from the point 
of view of the client. Such a pattern of 
organisation may :be logical for prolfessionals 
but often it does not meet the 
needs 'of clients and potential clients. 

The real sufferers, for example, from the 
multiplicity of departments ·and ~ervi~es 
involved in the care .and rehab1!Jtat10n 
of the physically handicapped are t!he 
handicapped. So many departments and 
occupational groups are involved _tha-t 
effective coordination becomes a nightmare. 
Increasingly, too, major problems 
conlfronting our welfare system-theneeds of the very elderly, the prolble~s 
of the inner city, the needs of the physically 
handicapped, t~e rehabilitati~m of 
the mentally hand1capiped-reqUJre . a 
multiplicity of professionals from d1~f· 
ferent departments. It is diffi~ult to avo1d 
the feeling that professiOnal~ need 
separate depa.J1tments for the1r own 
prestige and self-develoipm~nt r·athe~ than 
to provide the best possl'ble serv1ce to 
clients. 

The real weakness of professiot;~al notions 
of ·responsibility has bee~ ·~~e1r narro-yness. 
To see their respons1b1!Jty pure!y 1!1 
terms of responsibility to pa·rtJCula.r mdlvidual 
patients or clients is to take too 


limited a view of the world and the rol e 
of professionals within it. 

the claim for neutrality 

One of the historic strengths of the professions 
has been the 'belief that theycould be regarded as neutral in the conflicts 
of economic and political life. That 
neutrality has 'been powerfully challenged 
in recent years. Work with individuals, 
it is argued, is not immune from politicalanalysis. When so examined it is, al.m.ost 
by definition, conservative in its imp'lications 
because work with individuals does 
nothing albout " the system " ·and is therefore 
oriented towards symptoms. To 
regard ill heal'th or educational failure, 
for example, as purely individual problems 
is to collude with the existingeconomic and social order. Not to challenge 
the society which by its nature 
contributes to such ills is to help to perpetuate 
it-and the problems to which 
it contributes. 

Illich has argued, for example, that one 
of 'the functions-even if not an aim-
of the pattern of medical provision which 
concentrates on the individual is to 
eX'clude the health denying propertie o.f 
society from vhe agenda. What medicine 
does is to blur the health denyingelements of life in modern industrial 
society in an anti-depressant, druginduced haze. 

Professional neutrality has been attacked 
from another perspective too. Talk bydoctors and social workers ·of "treMment" 
fl()r the mentally 'ill and for delinquents 
suggests an activity which gives 
primacy to the client's interests and that 
what is being d·one is for his benefit. 
Critics would argue tha't it is society'sneeds not those of the mentally i'1l or the 
delinquent which are being served. Acts 
which are essentially political-acts to 
deprive individuals of liberty or act~ 
designed to alter patterns of 'behaviour 
-are being disguised as technical and 
neultral by being handed over to 
professionals. 

~ 

Activity which is po'litically neutral and 

pursued for the general good will 
obviously gain the support of all people 
of goodwill. Once the neutrality of such 
activity is challenged lt'hen ~the supportiveconsensus cracks and the activity becomes 
ex!posed to new kinds of debate and 
questioning. Political neutrality can 
justify power. When ,that neutrality comes 
under fire, power and privilege begin to 
be questioned. 

neglect of rights 

The charge that professionals trample on 
people's basic rights has been pressedvigorously in recent years in three main 
areas. 

The 1959 Mental Health Act set out to 
free professionals ·to he truly professional. 
The rights of patients were given relative'ly 
litHe thought-a't the level of legal 
rights or rights to adequate services. The 
fact that, as was seen earlier, compulsory 
patients have no right of appeal prior 
to admission gives ground for concern. 
Tf a patient does appeal to a Mental 
Health Review Tribunal the hospital can 
make available to the Tribunal information 
which is never disclosed to the 
patient-so he may lack fu'l! knowledge 
of the case a:gainst him. The onus on 
the appellant is to prove his normality-something ·which many members of the 
Fa'bia:n Society might find less than completely 
straightforward-rather than on 
the hospital to prove his mental illness. 
It is eXltremely easy for 'the consultant to 
inteDpret the a1ppellant's pleas as part of 
his symptomatology-the fact he thinks 
he could manage to survive ou1tside shows 
just how out of touch with real i'ty he is, 
for example. 

Another way in which bhe rights of 
mental patients are eroded by the professionals 
is the very great protectionfrom legal action by patients which those 
working with the mentally ill secured 
under Section 141 of the 1959 Act. Under 
that section the basic ·civil rights of 
patients to comp1ain about what is done 
to them while in hospital are substantially 
cuntailed. A complainant has to 
seek the leave of the High Court to 


pursue a grievance and leave will onlybe given if there is thought to be substantial 
ground for the complaint. 

The powers of the professionals in relation 
to delinquents have come under 
attack as a result of the rising critical 
tide against a philosophy of treatment. 
If treaitment is what it's all aibout, then 
the role of the professional 'becomes paramount. 
If the delinquent is in some sense 
"sick" his actual aot of delinquency is 
no more than symptomatic of a deeperunderlying malaise. He cannot claim tha-t 
his act was trivial and that his punishment 
should therefore be brief and 
simple. Again, if the sole focus is the 
welfare of the individual, proceduralsafeguards are simply a barrier to the use 
of •the most effective methods of resocialisation. 
In the best interests of the 
child, therefore, procedural safeguardsare widely neglected in the juvenile court. 
The very noticm of trealtment seems to 
make discussion ·about the rights of 
offenders, the procedures by whioh facts 
are established and so on, of secondary 
importance. Once the idea that what is 
being done, or should ·be done, is itreat


ment is challenged, then the issue of 
rights re-emerges as central-as it has 
in recent years. 

The other area in whioh it is alleged that 
professionals trample on the ri'gh1ts of 
clients is in the failure to supply information 
about a range of relevant issues 
and to secure a genuinely i·nformed consent 
to what is being undertaken. Doctors 
are poor at telling people what is wrongand what can, or cannot, be done about 
it. The Report of the Royal Commission 
on the National Health Service, for 
example, showed 1that a third of inpatients 
and a quar-ter of outpatients felt theyhad been given insufficient information 
about their treatment and progress (HMSO, 
1979). A-titer decades of research on the 
fallability of verbal communication, very 
few hospitals make any effort to supplypatients with basic written material about 
their complaint, the ·after effects of treatment, 
likely recovery period and so on. 
Parents of handicapped children make 
similar compla'ints--'they are offered a 
few crumlbs O'f information from (he rich 

professional table with no sense of a 
right to knowledge a-bout 1their children's 
condition and needs (T Robinson, In 
Worlds Apart, Bedford Square Press, 
1978). 

To fail to supply basic ,factual information 
in a form which is accessible and 
comprehensilble to the layman is normally 
dysfunctional to .the task in hand and 
tramples ·on a ba·sic ·right. The professionals, 
however, have shown litlle awareness 
of any problem. 

the service ideal 

It is probably fair to say tthat in recent 
years belief in the service ideal of the 
professions has weakened considerably.
In the 1970s ·the major welfare professions 
all did things which would have 
been unthinkable in the past. Hospitaldoctors worked to rule in pursuit of more 
money and a 40 hour week. For 
periods in 1975 and 1976 senior medical 
staff only treated emergency cases because 
they objected to the decision of 
the elected •government of Vhe day to 
remove private ·beds from the NHS hospitals. 
During 1979, several thousand 
social workers went on strike, some for 
many months. At various times teachers 
have left children unattended at lunch 
time as part of a programme of indus•trial 
action to further pay claims. 

The rightness or wrongness of such action 
is immaterial to the point at issue. What 
the general public S·arw portrayed veryvividly by the media was occupational 
groups, who assert an ethic of service. 
purs·uing industrial action from which 
those in need of their services suffered. 
Other material concerns were dbviously 
more immediately important 1han the 
concern to serve. 

Within the medi·cal profession there is 
a definite movement to clarify ·and narrow 
the responsibilities of the general -oractitioner. 
In 1979 a General Practitioner 
Working GI'oup CYf the British Medioal 
Association set out to re-interpret the 
profession's tr~ditional ethic of service 
with a demand for ex•tra payments for 


out of hours services and for additional 
services over and above what the group 
regarded as normal GP services. The 
Report marks a retreat from the broad 
concept of service which has contributed 
so much to •the GPs standing in the com· 
munity and to the justification of his 
claims for a special status. 

Ours, too, is a cynical society, less willing 
perhaps than in the past to accept altruistic 
behav'rour at its face value. The pleasof the professions about the ethic which 
guides their work are Jess likely to be 
accepted as statements of fact but are 
more likely to be regarded as specialpleas or as counters in a bargaining process. 
The ideal of service which the professions 
have always asserted as one of 
the major justifications for their position 
in society is being questioned. 

disabling effects 

Illich, of course, is the grea't ·expounder 
of the view that the professions have 
profoundly disabling effects (I Illich, et af. 
Disabling Professions, Marion Boyars,
1977), narrOIWing people's capacities to 
do things for themselves, creating dependency 
and so ultimately disabling people. 
Illich writes with dash and verve and an 
exciting mixture of error and exaggeration 
but there is enough substance in his 
allegations to g'ive them currency. 

Writing of •the professionalisation of pre· 
school education and the stress among 
so many of the professionals that this is 
a professional task not properly to be 
undertaken by non-professi.onals, LadyPlowden suggests that "The confidence 
of parents in themselves as :parents, in 
this rapidly changing society, where the 
urgent need is 'for confidence and securitv. 
has been lessened. It is 'they' in 
nurseries and schools who know best. 
from the earliest months and years of a 
child's life" (quoted in H Land, "Who 
cares for the family? " Journal of Social 
Policy, 1978). 

Teachers can disable some of those they 
seek to teach-just as they enable others. 
It would be odd if they did not. Negative 

attitudes to a child's background and 
experiences can do this, so can method 
of classification which limit or downgrade 
a child's expectations of himself, 
so can hostility or lack of encouragementtowards parental involvement in 
education. 

Illich has expounded at length the 
" health denying effects " of the health 
professions. Childbirth has been medi· 
calised and as a result " the desire, comp
·etence, and conditi·ons for autonomous 
behaviour are being destr.oyed" (I IUich, 

The Right to Useful Unemployment,

Marion Boyars, 1978). 

People cease to feel the responsibilityfor maintaining their own health which 
they used to feel, or so it is argued. The 
result is the dependent, disabled patientmaking unnecessary demands on professional 
services because he has been 
schooled to the view that the doctor-
and only the doctor-has all the answers 
to all his health problems. 

The charge against social workers was 
neatly summed up 'by the Daily Mail, 
"By their very exis<tence ", it shrieked 
in a venomous attack, "they not only 
stop individuals doing th'ings ·for themselves, 
they stop groups and ·communities 
doing things f.or their fellow citizens" 
(18 January 1980). 

The argument is a double one. By freeing 
people from responsibilities which are 
rightly theirs, dealing with difficult 
children or coping with difficult elderly 
relatives .for example, peopl·e become less 
alble to cope with the other responsibilities 
which life brings. At the same time, the 
availabili>ty of public help deprives ind ividuals 
and groups of both the incentive 
and the necessity to provide their own 
services. That this can be true is scarcely 
open to debate. The crucial point is the 
frequency and strength of such changed 
attitudes in society. 

Certainly the standing of the professionshas suffered .from the attack on their 
disa'bling function. It has helped to encourage 
a critical rather than an accepting 
attitude towards them, even if erected 


on a r<l!ther insubstantial foundation of 
assertion and allegation. What has given 
this attack added ·force is the fact that 
it has come at a time when i·t has become 
very clear that the success of the professionals 
is hea'Vily dependent on active 
participat-ion by their clients-for examplein self-care in health or parental involvement 
and encouragement in education. 

lack of accountability 

Central to the contemporary mood of 
scepticism and uncertainty about the 
powers and privileges of the professions 
is concern about their accountability.
Just how responsive and accountable are 
they to popular, politi'cal and client influence 
and authorjty or are they in 
reality a law unto themselves? As the 
professions have impinged more obviously 
on more people's 'lives, <the ·issue has become 
obviously important. The contrast 
between publi'C financial support and the 
lack of clear pubi'ic control has got rather 
too sharp for comfort. "Although the 
government is the main source of empl•oyment 
and remuneration for doctors. 
teachers and social workers", write Adler 
and Asqu~th, "the doctors' clinical free dom, 
the tea·chers' control over what is 
taught in the schools and how it is taught, 
and the social workers' decisions about 
what kind of help, if any, should be given 
are largely immune from any form of 
democratic accountability and contwl " 
(M Adler and S Asquith, Discretion and 

Power, Pruper presented t-o SSRC Work


shop on Discretiona•ry Decision Making. 

Edinburgh, January 1979). 

There are clearly strong arguments for 
professional autonomy. Much professional 
work is difficult if not impossible 
to supervise. Then there is the argument 
that only other professionals are competent 
to understand and assess professional 
work-in Lord Harder's immortal 
words "Only the doctor knows what 
good doctoring is". A •third argumentis thM in a supposedly f-ree society, the 
professionals should 'be autonomous to 
eiiiSure ·freed·om from the state. The 
problem is balancing a necessary or 
desirable freedom with the reality of 

work in publicly organised, publiclyfinanced servi-ces committed to demo cratically 
agreed public purposes. The 
current crit·ique argues that the freedom 
which t~e professions currently enjoy-
though In different degrees-is not fully 
c~mpatible with their role 'in public serv.
Ices. Cases such as that of Wi'lliam 
Tyndale school (cf J Grebton and M 
Jackson, William Tyndale, AHen and 
Unwin, 1976), ·it ·is •argued, show a degree 
of freedom f.or tellJchers which is incompatrble 
wi'th parental rights. Similarly the 
scandal at Normansfield HoSlpital (cf

Report of the Committee of Inquiry into 
Normansfield Hospital, Cmnd 7357, 
HMSO, 1978) shows a breakdown of 
ma.>nagement and a clinical freedom which 
has clearly reached the level of Jiicence. 

Another area of discussion when the 
accountability of the professions is under 
considera•tion is the nature of the complaints 
and appeals machinery, its access-ibility 
to potential and actual complainants 
and :its efficacy in reso'loving oomplaints.
In health, mach:inery eX'ists, but is complex, 
cumbersome and, as i·t must seem 
to complainants, !biased ~n favour o.f the 
pwfessiJona1s (See for example R Klein, 
Complaints Against Doctors, Knight,
1973: Report of the Committee on 
Hospital Complaints Procedures, HMSO, 
1973 ; Report of the Royal Commission 
on the NHS, HMSO, 1979, chapter II). Jn 
educa6on and personal social services 
such mach'inery scarcely exists .in a formal 
way. 

If challen-ged, professionals wi!J declare 
that their primary accountability is to 
their individual clients. Secondly, they 
a:rgue that they are accountable to their 
ppofessional peers. Neither of those 
defences w.ill sa·tisfy the enqu'irer who is 
not positively seeking to be satisfied. 
There are reaJI, lively and pertinent questions 
a!bout professional accountabili-tywhich are being asked of all the majorwelfare profesS'ions. Such questions are 
important in their own r.ight and as part 
of the br-oader questioning of the place 
of professions in a more educa·ted consumerist, 
democratic society concerned 
a!bout r-i-ghts, effectiveness and efficiency 
in public expenditure, individual and 


i6 

social development and the nature and 
exercise of power by groups within 
society. 

conclusion 

The current cri·tique of the professionsis a broad one. At its heart is a concern 
about power. Apart 1from a small, excitarbte 
and unrepresentllitive lunatic fringe 
there is 1ittle desire -to a!bol'ish the professions. 
What is •increasingly widespread 
is a desire to re-examine their role and 
work out a more appropriate rela~i:onship 
be~ween the professions and society than 
that wlrich currently exists. 


4. towards a policy for 
the professions 
The second and third chapters surveyed 
the nature and extent of the power of 
cer.tain pwfessi!onal graups in social welfare 
services and then eX!plored the main 
lines of the ·current critique o.f the professions. 
What is clear is that th:e chargeslevelled against .the professions are 
numerous and serious. They stand accused 
of using ·their power and influence in 
policy making and administration to 
further service developments which serve 
professional interests r·atber than the 
public interest. The views oof need and 
the definitions of problems which theyproclaim as objective and scientific are 
indicaoted as narrow, partisan and value-
laden. Professional power over resources 
is used, it is suggested, to serve professional 
interests rather than to fur·ther 
democratica~lly agreed priorities and plans. 
The power which professionals exercise 
over people is often ex:ercised without 
due process or any effective right of 
appeall. Professional control orv·er the area 
o'f prQfessional work perpetuates a particular 
model of work, a particular type 
of entrant and a ·type of training determined 
·by elitist elements in the professions 
rather than 'by client need. 

These results of professional power are 
not the products of any con~ci•ous evi<l 
designs. Profess.ionals do not set out 
deliberately •to plan services which serve 
prdfessiona1 rather than client interests, 
or to negate agreed priorities, or to secure 
powers over people •which criti•cs regard 
as oppressive. What leads professionals 
to pursue the pOJlicies which provoke such 
accusations is a particular view of their 
role, competence and relia•bility which 
form·s the basis of a•n ailliance with 
government in their respective fields of 
work. Governments in we~fare states 
need expertise and disinterested advice. 
The professions put themselves forward 
as able to meet this need and governments 
accept the olaim un·critically. Theydo not realise, neither do .the professions, 
thM what is being offered is partisan 
advice based on opinion rather than on 
agreed fact. 

What is 'being criticised here is, in fact, 
the ibasic modeil. of professional work. 
Professional advice gains credi•bility be


cause of its supposed scientific nature 
but -that is open to question. The paternalism 
of professional activity is attacked 
as ~eading .to the neglect of dients' rightsand to their disablement. The polioticalneutrality of ·the professions is unmasked 
as fundaJmentail conservatism. Account-
a~bility to the professional peer group is 
cha:llenged as an excuse .for avoidinggenuine accountability ·aond as effectively

•insul<at·ing the profession, physically and 
psychologically, from comments and 
judgments of ol'ients aJnd users and of 
avoiding working out what professional 
responsibiiity means ·i·n publicly financed 
services. What is at issue essential:ly is 
the rela•tionshilp of the professions to 
soci·ety, •tO their clients ·and-less obviously 
but very importantly-to other professionals. 
What is required is a new 
modei of professional work and a strategy 
for i·ts aHainment. 
The only model which is both functional 
to the role which the professi·ons playin our kind of society and which is acceptable 
to democrats and socialists is that 
of partnership-partnership with clients, 
partnership with society and partnership 
with other profess.ionals. 

Such a partnership model will obviously 
mean different things in different professions 
and on:ly its general ouUine can 
be sketched here. It means professiona!lsaccepting patients, clients or parents as 
partners in the •task of medi.cine, social 
care, ¢ ·anning or education. This means 
a sharing of information, ,a discuss·ion of 
what is being done and why, and an 
acceptance of the lay person's right to a 
say in the decisions which have to be 
made. Decisions about the ama:lg,am•a1tion 
o'f practices, alteration of surgery hours, 
the adopt1on (){ aJ~ppointments systems, or 
changes in arrangements for emergency 
cover, for example, would be made only 
after discussion with paJtients. Equally, 
in eduoation, matters of school org·anisation, 
streaming and unstrearning, banding 
or setting, or the introduction of new 
reading schemes, for example, would be 
the subject of discussion between teachers 
and parents. Partnership means shared 
decision making, mutua!! respect 'and 
shared responsibil·ity. It means tha<t the 


professional moves much oloser to his 
clients. They .become his key reference 
group as important as his professional 
peers. 

The idea of prdfessional work as a partnership 
with society means no more than 
an e~plicit recognition of the reality of 
work in publicly financed services designed 
to fur-ther public purposes. In such 
a situation ideas of rpwfessional .autonomy 
fit iil with the. rea!hty of <the si1tuation. 
Professionals cannot ·avoid a close relationship 
'with the socia:l pu11poses of the 
stMe, f,or it is the sbate rather than the 
individua!l which becomes .the client ; the 
state declares ·the need and rpays for it 
to be met. What professionals have so 
foar been relucant to [ace is .the respons~
bilities .which fol!low 'from such a position-
responsibilities in resour·ce use, in 
the fur·thering af publicly agreed priorities 
even i•f they generlllte little enthusiasm in 
the prafess·ion, in accepting the ~egitimacy 
of management action to set 'boundaries 
to the eX'tent of professional freedom. 

P·artners'h'ip with society means greaterprofessional acceptance af political authority 
and the rights of .government to 
determine prrorities and to fix the basic 
terms of the professional work. Such 
grea'ter professional identification with 
public purposes wtill 1be in direct and 
creative conflict with the new partnership 
relationship with clients, because that 
wil:l lead professionals to a much closer 
identification with the services in whi·ch 
they work and so to ·a much more criltical 
approach Ito the levels and s'tand~rds 
o'f service provision. At the same ttme, 
partnership means that the professions 
become more closely involved with serving 
pubhc purposes and more cri~ical of 
public ao~on on beha'if of their new 
partners, their clien!ts. 

Increasingly, successful rprofessiona:l intervention 
in one sphere of l'ife depends on 
collalbor·ation with other professionals-
in the oare ·of the menta!Jily handi·capped, 
the chronic sick, the e'lderly, children in 
trouble, pwblems of poverty and the 
inner city. Professional·s, however, are 
soci~ised in isolation from each other 
to the performance of narrowly defined 

tasks. They tend to see their own skills 
as the key ones around which others 
should be organised. The fact !that social 
welfare serV'ices are organi·sed around 
professional skills rather than client needs 
shows the strength af professional independence. 


~rtnership with chen<ts and society must 
be complemented by rpantnership with 
other rp.rofessionat groups-doctors with 
sooia;l workers, social workers with 
teachers, teachers and social workers with 
pl•anners-and so on. The triparti.te nature 

o:f the model af partnership which is 
being suggested has important balancingeffects on professional work. The partnership 
with society, which could lead to the 
tatal subordination of a prolfession to 
pubJiic purposes, is balanced 1by the profession's 
partnership with individuals, so 
the profession does not !become simply 
the slave of government. Similarly, stress 
on the partnership af •a profession w~th 
other prdfessions can be a ·check on the 
poltential exdusiveness of an emphasis 
on professional partnership with indivrdual 
cloients. 

5. the strategy for a new 
relationship 
It is not <to·o difficult to produce a new 
model for professional work. What is 
rather more difficu1t-as with aU schemes 
of socia.l reform-is to devise a strategyfor change and to secure its implementation. 
There are two ·dbvrous ~nitial pwblems. 
The first 'is that those with power 
and privilege are generally less than 
eager to assent to their dilution or remOV'al 
without protest or resistance. 
Seoondly-a:nd almost as impor~antthose 
rwho have never had power or 
influence in relation to professiona'l serV•
ices-dients and patients, parents and 
slum dwellers-are reluctant to assume 
them with any vigour or enthusiasm. A 
partnership model of professional work 
depends on change ·in such attitudes. 

There are, hawever, some signs of hope. 
In the social services which are our main 
concern, trends in 1thinlcing and in some 
pioneer,jng experiments suggest ·the need 
for rethinking the traditional role of the 
professtions. Stress .on self-care in health 
places the individu:a'l in a potential1y new 
relationsmp with the medical profession, 
one df shared responsibility. Research 
findings about the imp'O'rbance of parenta:l 
encouragement to children's educational 
success ~hallenge ,the tradiltional separation 
between home and school and create 
imporltant educational reasons !for greater 
parent-a:! involvement with chi'ldren's 
schooling. In -the broad area of social 
work, the development df a wide range 
of se~f help groups-alcoholics, the mentally 
ill, parents of mental'!y handicapped 
children, single parents, for example-
shows just how much people with similar 
problems can do to support and helpeach other. Such g11ou;ps want and need 

a quite different relationship with social 
work staff; they have become partners 
i-n meeting thei•r own needs. 

Some members of a:ll the profes~ional 
groups which have been discussed have 
discovered the very tangible ·benefits of 
seekling a new relationship with those 
seeking their services. Docrors have 
sought to educate their patients aJbout 
when and why to call a doctor, about 
what he ·or she can (.nd cannot do. T~akingtime to e~pllain a symptom or a treatment 
and l-ikely reacti·ons has been 3hown 

to reduce what were prev~ously regarded 
as trivial consultations, but which were 
in f•act the product of a particular model 
of medicine. Social workers, too, have 
found that a frank explanati•on of what 
they can and cannot provide reduces dema!
nds which they cannot meet-and so 
their own dissatisfiacbions. lt has been 
shown that Patients' Committees, active 
and lively Parent-Teacher Associations, 
groups of local users of social services 
can be a help rather than a threat to 
professional work. 

So there ·are 'trends and developments 
wi'thln the professions and the services 
in which they work whi·ch suggest the 
possibdlity of new models of professional 
work. So, too, do some •aspects ·of broader 
sooia.l change. In the last dozen yearsauthority rela!tionships ·Of all kinds have 
been challenged. There is Jess deference 
to autho-rity of all kinds-partly because 
of the spread of educat~on, partly because 
authority .of all kinds has been so often 
exposed a:s fragile, incompetent or 
corrupt. One specific aspect of this challenge 
is the growth of a cr~tical consumerism 
in the commercial fiel-d and this 
has naturally washed over ·in'to the social 
weLfare field. Increased concern amongpoliticians and administrators for effi·ciency 
and effectiveness ·in resource use 
in a situation df non-growth has made 
them more curious about how professionals 
use resources and the rationale 
£or particular pa'tterns of resource use. 
Efficiency •and effectiveness provide a 
legivima'te rat·iona.le for managers to ask 
critical questdons about what is •being 
done, how and why. And the high cost 
of professional services in svaff 'training, 
salaries arrd support is leading remorselessly 
rtu the question of whether pro


fess·ionals •a'l"e reaHy .worth that much 
more than lesser itra~ined ·or untrained 
staff. 

There may be hopeful glimmerings of 
posstibili'ties of change. What ·is needed 
is to take advantage of •the favourable 
signs and trends and push forward 
vigorously with deveLopments calcul•ated 
to further the desired partnership. 

One importan't development whi·ch 


government could foster is the growth 
O'f ad hoc jns~itu't~ons for lay involvement 
in the government of organisations which 
have hilithe.rto been dominated by professionals. 
I.t is at the level of the school, 
the social servj,ces area ·office, the grouppractice or the health centre that the 
aotiV'ities of the weHoare professional·s 
impinge most directly and immediatelyon those usirrg their services. It ·is at this 
local 'levcl that the traditional machinery 
of democratic control •through Parliament 
~and local council is least effective. 
It is where professionals and people 
a:c~ally meet that both parties have most 
tJo ga•in 'from irrst1tutions to aHow discussion 
of common issues. 

Simply creating a rash of patients' committees, 
ad hoc committees oof plannersand residents, parent teacher •associations 
or more rep·resenta:tive school governing 
bodies is •dbv~·ously not going to create 
overnight a new rela~ionship bet•ween 
doctors •and pauients or parents and 
teachers, planners and the public. There 
is going to he 'hostility, susp-icion, apprehension, 
deference and uncertainty at the 
start and these wiH only disappeargradua:lly. What ~t does do, however, is 
to make possible the eVlolution of a new 
reJ.a:l!ionship. 

the benefits of cooperation 

How •are such developments to be encouraged? 
Hrstly, the benefits to professi•
onal:s and service users 'can be clearly 
spelled out by the appropriate government 
departmen'ts to pr.ofessionai associati,
ons and to and through, ifor example, 
Area Health Authori.ties, Ramily Practitioner 
CQIIUJllittees, l:ocal Education 
Au1thor:ities, Social SerV'ices Commil:'tees. 
There is a strong case to be made for 
the :practicrul adv.anta•ges to aH partiesin seeking a new rel•ationSlhi.p. It has never 
effectively been made and this is a first 
step. 

A second step is to provide tangible 
encouragement and incentives l'o such 
developments. Small grants to be spent 
for the benefit of the school, the group 
practice or the social serv.jce area could 

be made to patients' commil:'tees, new 
style school governing :bodies •or social 
services users' committees once they were 
estabhshed. If ·these grants increased 
year by year, on condition such representative 
bodies were funcl!ion:ing, so that 
an increasing proportion of the agency's 
budget was subject to the contwl of the 
ad hoc representative body this would 
pr.ovide a powerful incentive to even the 
most unenthus'iastic professionals and 
cl1ients to get together. Such funds would 
remain at the level of amen1ty !funding 
rather than being a substantial proportionof the ·organisations' runnin·g costs, but 
such provision would pr.ovide t<l!ngibleincentives to all :parties to coopera!te. A 
small increase in pupi'l crupitation allowances 
to be released to schools showing 
ev.idence of an acl!ive rel•ationship with 
parents for the PTA .or the school governing 
·body to spend, or a small grant to 
be made .available to the pa.tien'ts' committee 
for improving the gr.oup practice 
or the health centre amenities would be 
a real spur to development. 

There is much to be sa;id far movingforward through persuas'ion and incentives. 
There is no reruson, however, why 
provi&ion for such representative bodies 
should not be included in legislation. 
There -is statutory provision for all 
sch:ools to have managers or governorsand the principle could be ex:tended to 
other services and developed so that the 
bodies became genuinely representative 
of those actuaHy using the services. 

The aim of creating ad hoc participative 
·institut~ons :is, in the first ins~ance, to 
create a forum f.or discussion .of common 
pro'blems .bebween professiona1s and service 
users. It cannot he mo·re, gi-ven the 
constraints ·imposed by the ex1istingsystems of ~ocai government and health 
service administrati<Jn. And establishingsuch institutJi,ons, simple though it maysound, is in fact a major undertaking. 

Evidence from one early patients committee, 
.for example, suggests ;that 'it can 
take several years to estahl·i'sh a lbodywhich can claim to 1be moderately representa-
tive ·and has attained a measure of 
self confidence (I Shaw, Patient Partici



pation in General Practice, ·Welsh Con sumer 
Council, '1978). 

A second ·1ine af •policy which must be 
pursued by any government concerned 
to esta:blish •a new model Q{ profess'ional 
work is the establi·shment 10f more effective 
and accessible complaints and lllppeals 
systems lfor those who ·are dissatisfied 
with their treatment in rprdfessi.oa~ serV'i
·ces. In no area .of s·ocial tp;Ol•icy is there 
machinery .wh'ilch coul'd at present >be 
considered adequate. Of the profess·i·onal 
welfare services~hea'lth, education, planning 
and personal social ser·vices-'onJythe NHS has ·a lf.ormal complaints system. 
As Wa1S rpointed out ea:rlier, i•ts vari·ous 
elements bave been thor.oughlly examined 
in ·recent years-'l!nid ,f·ound sadly wanting. 
The system us compleJQ and the procedures 
are 1engthy •wh'ile tits scope at the level 
of .general tpPaotice is res•tricted to 
'breaches ·Of •contract, •so exduding from 
consideraVion matny ,oJf the ·i·ssues which 
most worry patients. 

a complaints procedure 

What is needed is .a simple, accessible, 
info11mal system if.or deahing 'Wiith complaints, 
'including complaints •ll!bout the 
exercise .of professional and clin:ica•l judgment, 
tin all services. 'It would deal with 
complaints ~bout the nature of the service 
·offered ·as we11 as .appeahs agains·t 
refusa:l ,Qif service. Each Area Hell!lth 
Authority, Loca:l Education Authority, 
Social Services Comm'ittee and Pl,a•nning 
Committee could estalblish such a 'bodywith a panel of members tfrom which 
paPticu1ar aippeal :committees w·ould be 
constituted. The chaii1persons ·of such 
committees should be laymen with some 
know·ledge df the •field. The relevant profession 
·should he Tetpresented but l·ay representati'Ves 
should be lin a majoPity to 
counterbal,ance the natural deference 
shown by laymen to pr.afesstonals. Experience 
has •shown that appeal systems 
which do n·ot pr.o'Vide Tep:resentation for 
appellants are unsati\9factory so some 
guarantee ·df tep·resentation would 'be 
necessary. 

Such a system would need to .be supported 
by in:formal condliation machlinery 

w1thin deparbments which s·ought to 
sauisfy ·comp:laiinants so !that they felt the 
need >to invol'Ve the formal machineryonly 'in exceptional circumstances. 11here 
would also need to he a .broadening of 
the 'terms of reference ·of the Par!'i.amenbll!
ry Commisslroner for Administration, 
the Health Service Commissioner and the 
Local Omlbudsmen so that they •could 
both take direct complaJints 'from rpeople 
with grjevances, move beyond narrow 
issues ·otf madadministration and examine 
complaints against the ex•ercise o:f c'linica'l 
judgment. 

There ·is no sati'sfactory easy way of 
inf.orming .people about :theJir rights of 
complaint and appeal because, !for most 
people, occasions .of complaint are rare. 
A •relatiomshi.p of partnersh1p between 
professi•onals and clients should lead to 
a greater acceptance of the >laity's right 
to complain while at the same time 
making f.or the easier reso'lution of diffi cuUies 
through d.iscussi.on lilt ad hoc 
participative 'insVitutlions. But the principle 
of a Tight 00' compJ.aint and .appea'l is 
impor·tant. It is recog~nised and expressedwitth relucance 1n the present protective 
maze which suProunds iprofessi·onal servliiCes. 
That maze does nothing t-o help 
a constructive relationship between professiona~
s and those •who use their 
services. 

A third development which could contritbutte 
.to the new relatli•onship between 
the professions and society is the establishment 
·of .a :body such as ·a ParNameD'tary 
Select .or Stand1ing Committee for 
the 'Professions, or some k'ind .of permanen!
t Council f or the P.rdfessi•ons. 
Rudolph K·lein hatS suggested the need 
for such a ibody on a number 'Of 
occasions. The aim would he for a Jbody 
of appropriate memlbershlip, wi'th a laymaj-ority and necessary staff, regularly 
to coHect and 1pub!ish mater.i.al about 
chosen aspects of rpr.ofess1ionaJ organisation 
and prad~i.ce such as compla'ints and 
atppealls procedures, methods df monitoring 
standards ·of work, how the .professional 
·associ.ati.ons :Were exerdsing their 
various powers and TesponsibiliVies. Such 
a body could subject prOO'ess'j.onal organisa'tiollis 
and practiiCes to lthe kind of 


l2 


cr-itical and pointed ques1ioning which 
they so easily escape at the moment. It 
might, •£or example, ca:rry •OU!t a regularreview ·of each ma~jor social welfare profession 
'looking at the patterns md relevance 
of tra:ining and educa'rion, the 
degree of flex1ljihty in adapting to new 
needs, nts readiness to accept research 
findings, its effidiency and effectiveness 
and the extent ·af con~umer satis'faction 
or d.issat!is£acti.on with •the service being 
provided. If •government ijS to attempt t-o 
work out a policy f.or the prafessionsthere ns clearly a need 1for some kind of 
publlic '0'1' parliamentary body -to .oversee 
such a !policy. A Select or Standing Committee 
would root the issue firmly in the 
politiCaJl field whi•ch •is where 11t needs to 
be located. 

A fourth development wbiich is a prerequisite 
olf a new model df pr.ofessiona1 
work ~s a new attitude by government 
to the professions. Governments have 
been over deferenti>a:l in •recen!t decades 
to profess.iooa1 daims ·~o expertise, •independence 
and authority. Di>scuss'ion with 
profess·1onal bodlies has an many occ~i'ons 
approximated far too close'ly to negotiation. 
Governments need to accept aga:in 
the legitimacy df poli·tical authority and 
control •and the dulbious and illegitimate 
nature of the pleas of ·interested parties 
of aU ·kinds ·for spedia:l privileges. Government 
and 1esser politlica'l and managerialbodies are o£ten excess.ively relucbant to 
~sert the legitimacy .of :their authori'ty. 
The Committee of Inqui•ry into Normans-
field Hospital t'aclcle'd .this issue of the 
re'lationsbiip between pr.ofessional and 
politicaJ authority head on. " Health 
authorities", it concludes, "have a right, 
and indeed a duty, Ito s.tipulate, if they 
fee1 >it necessary, rthe pattern of life that 
they wlish to provide in the hospitals .f.or 
which they are ·respons'ible (this parlticularly 
applies to long stay hospitais) ; and 
it •is equaUy their duty to take disciplinary 
>acti·on agaJinst any employee who 
de'liber'aJtely lthwar.ts thek !intentions . . . 
They should not ·a.1!ow themselves to be 
confused, s1iU less stopped ·in their tracks, 
by the use af such terms as 'dinica'l 
responsibility' " (Report of the Committee 
of Inquiry into Normansfield 
Hospital, HMSO 1978, Omnd 7387). 

A>gainst profess.ional daiims--:imp'licit m 
exphcit-thM their obedience is to some 
higher au~hority, •pollibildians and managers 
can ·asser.t !their .own obedience tto the 
democratic will af the people med'iated 
th•rough .Parlliament or the processes of 
l·ocai government. They can, and should, 
take to heart the v.ie~ expressed lby •the 
TayJor Cornmilt:tee ·on the justification£or lay involvement in ·~11 aspects of •the 
hfe of the school. "A school", the Committee 
pointed out (and they could have 
saJid the same -of a health service, ·a personal 
s·ocial serv·ices department ·or a 
planning depa·rtment) " it not >an end in 
itself ; ,it is •an institution set up and 
financed by society to achieve cer.tain 
dbjectives which so.oiety regards as 
desirable" '(A New Partnership for Our 
Schools, HMSO, 1977). That statement is 
a complete justificartlion ifor the asser.tion 
of poliJtica:l 'and managerial •authority over 

prdfessional spediall pleading. 

asserting politi·cal authority 

Government needs to .take the .offensive 
·against the prafesSI.i.ons md pulblioise 
some df the arguments albou>t failures of 
professional responsibihity, neg:lect of 
people's .rights, the relrutionship between 
pr.ofessiona1 cl-aims and achievements, the 
rather tarnlished nature •of the se.rv.ice 
ideal, the way 'in which pwfeSSiionalsrefuse to accept accountability to •anyone 
except their peers. Too dfiten the professwns 
a'fe al[owed to escape the kind of 
dose questioning 'to which governments 
should expose them. The professions have 
no monopoly ,df wisdom about priorities 
or service organisaJtJion and no inherent 

•right >to set their own term~ ·of work. 
These things need to :be sa!id-and 
governments >are undu1y reluctanrt: to saythem. 
Whi1e asser.ting the 'primary ·df poJ.i1!ioa1l 
authority goverment should al>so encourage 
the pr.ofessions to set their own 
house in order. Prafessj.ona;! self ·regula·
ti.on can make a contribu'llion to maJintaining 
the standards ·df professiona1 WO'l'k 
but sadly no prafession has shown anythill'g 
'but the most lukewaJrm ·interest in 
monitoring and maintaining the standard 


of work of 1ts members. ·Professi.onal sel1f 
audiit could con1Jiibute to a new relationship 
!between prdfession and s·ocietythrough inducing a new professional! self 
·consciousness a:bout resources used and 
the distdbuti·onal ·implications of the 
decisions made and 'aibout the need .for 
cooperation Wlith ·other pmfessliona'is if 
dient needs are not to be neglected. Self 
audit shows a serious commitment ·to 
impr·oving and maintaining standard~ of 
work. Onil.y professional bodies can audit 
some aspects of rp·rofessi·onal ·work. 
Government should encourage the pr.ofessional 
bodies to see thaJt the ·standingof 'the pr·ofession depends on the qua:li:tyof its members' work and 1that al·l its 
mernbers---lll.nd the publlic-sotand ·to ga:inby the 'l"eview ·of performance from which 
pr;ofessionals have too aong :been immune. 

In the United States 1the Pwfessiona·l 
Standards Rev.iew Or.ganisaotions proVJide 
a p·otentia:l model :for •a system •o'f self 
audit in medicine and other fields. There 
'i•s a Nat:ionall ,Professional Review Council 
which :ha:s V<l!rious sta<t:utory duties-to 
esta!blish ~ocaJ norms of diagnosis and 
treatment, to esta:blish norms for the 
1ength d.f hospita1 stay and to pmvidefor the review ·of 'these lf.or !individual 
pll!tients, to constroct "profi'ies " of the 
work of individual doctors and •instituti-
ons. The aim •is •simple and unexceptioonalble-
4o see !that •all medioal treatment 
given ois medicalLly necessary and is of 'an 
approp11iate ·standard ·df qua:Hty and care. 
It is a job wruch needs to he done and 
which is !best taockled by professionalbodies of some kind. But governmentneeds to make ~t pl•ain that if <the professions 
are not prepared to cooperatein this task it w.~U have t:o creaJte Hs ·own 
methods of audit and supervrision. 

conclus·ion 

There are no easy solutions to the problems 
posed by the posit-i-on of ·the professions 
in modern society. Lt is ·one particular 
•a:spect ·of the relationship :between 
techll!ical and politica:l power which 
Daniel Bel:l bias descr.ibed as " one .of the 
most .cruoi,al pwblems df pul>lic policy " 
(D Bel:!, The Coming of Post Industrial 
Society, Basic Books, 1973). Enough has, 

however, hopefully <been said to show 
that the power wielded by ·the professionshas often worked to the det11iment of 
those they pUI1pOJ:1t to serve. Thei'r rel'at1onship 
with their ·cLients and societyneeds rethinking lboth -on pragmaticgrounds ·of service effectiveness and ·on 
the •grounds of democratic princip:le. 

The 1professi·ons have, lin ·the past, sought 
to asse1:1t themseilves as somehow a,'bove 
and beyond normal government 'control 
because ·of ·dbedience to some higherethic. Such Claims cannot •be accepted. 
In a democratic society, .the professions 
have no claim to :polriticai 'immunity.
Accourrtabi'lity •to those using rheir services, 
lllnd to those who manage the 
services in which .they w.ork, and to the 
political bodies which employ them hru<i 
to tbe re-esbabl1ished. Some sugges~ions 
about how ~his pmcess migh!t tbe ·begunhalVe been outl<ined lbut clearly different 
insti'tuti'ons and procedures a·re needro 
in different 'Services. 

Something ·can ·certain[y 'be achieved 
through the esta:blishment 'Of new ad hoc 
representative in:sHtuti.ons, the improvingof 'Complaints and appea1s 'Systems, the 
crea1Jion of a Select CO'mrnittee ·or Council 
for 'the Professions, the rea:sser.ti'on by 
government ·of the -legitimacy 1df politicaland manll!ger.ial authority and the stimulation 
-of 'Ol'liHcail sellf audit among the 
professions 'themselves. 

Much ·can be achieved •by education, 
persuasion, encouragement <and lincenbi·ves 
but a1 lthe end 'Of the day the obstinate 
a'Ssertion of pr·ivi·lege at lthe expense of 
the rgenerall good 'Canndt be tol-erlllted. 
Compulsi,on may 'be necessary if governments 
are :to fulfil ·their responsi:bil·ities. 
ULtimately, however, the need for changes 
in the position, powers and pl1iV1ileges of 
the professions cannot <be isol,ated from 
the need ·fior more genera:! radi~«l changein society. Writing a'bout :the resdlution 
af the •relationship lbeltween the medical 
professi·on and society, George Bernard 
Shaw was quite clear ,that "The s·ooiall 
so1ultion ·df the medica:l problem depends 
on that ·l<arge, sl,owly advanCing, pettishly 
resisted i·nltegration of sooiety, generally 
ca:l!led •socialism" {G B Shaw, The 


Doctors' Dilemma, Oonsta'l>le, 1947). If 
the professions are to be genuinelysocialised, •society ,jltself has got ·to change 
r.adicaUy but it is cer-tainly pos•si•IYle t'o 
begin 'that pr.ocess of genuine s·ociadisation 
here and now. 


recent fabian pamphlets 


research series 


331 Chris Ralph334 Carl Wilms Wright 
336 Christopher Parsons 
337 Robin Cook, Dan Smith 
338 Alan Fox 
340 Deepak La! 
341 Tom Sheriff 
342 David Scott Bell 
343 J. Goode, D. Roy, A. Sedgewick 
344 A F~bian group345 David Taylor346 Robert Taylor 
347 David Sa'in!!bury 

The picket and bhe law 60pTransnational corporations 75pFinance for development or survival ? 75pWhat future in NATO ? 75pSocialism and shop floor power 60pPoverty, power and prejudice 75pA deindustrialised Britain ? 60pEurocommunism 80pEnergy policy : a reappraisal 80pCan tenants run housing ? 70pIndia: : the politics of change 75pThe crisis of American l~bour 70pGovernment and industry 80p 

tracts 


451 Dianne Hayter453 Nicholas Falk 
455 David Watkins 
457 Tom Crowe, John H . Jones 
458 Robert Taylor460 Walter J aehnig 
462 Bryan Gould and others 
463 Austin Mitchell 
464 Giles Radice 
465 Peter Scott 
466 C. Pond, L. Burghes, B. Smith 
467 Trevor Barnes 
468 Evan Luard 
469 Peter Hall (ed)
470 Roger Carroll 
471 John Bowers, Suzanne Franks 
472 John May 

young fabian pamphlets 

The labour pa·rty : crisis and prospects 60pThink small : enterprise and the economy 75p 
Industrial common ownership 65pThe computer and society 50pLaJbour and the social contract 65pFamily service for mentally handicapped 60pThe poHtics of monetarism 60pCan Labour win again ? 75pComniunity socialism 65 p 
What future for !higher education ? 70pTaxing wealth inequalities 65pOpen up I 65pSocialism at the grass roots 65pA radical agenda for London £1.00 
The two wage worker 65pRace and affirmative ·action 75pJustice, welfare and juvenile delinquents 80p 

42 Martin Smith Gypsies : where now ? 40p44 Melvyn Westlake World poverty : the growing conflict 70p45 Geoff Harris A wider Europe 50p46 David Elliott The Lucas Aerospace workers' campaign 60p47 Tom SchuMer Education through life 65p48 Mark Swift A regional policy for Europe 70p49 Mark Goyder Socialism tomorrow 80p 

books 


R. H. S. Crossman and others New FaJbian Essays cased £1.75 
Brian Abel-Smith and others Socialism and affluence paper £0.60 
Peter Townsend and others The fifth social service paper £2.50 
George Cunningham ( ed) Britain and the world in the 1970s cased £3.00 

socialism and professionalism 
The values of socialists and of the public generally are roften incompatible 
with those of professional groups. In this pamphlet Paul Wilding examines 
the autonomy enjoyed by professionals in the social welfare field-teachers, 
doctors, planners and social workers-and the conflicts that arise when 
that autonomy, based ·on a narrow expertise, is used to influence policy in 
the essential political areas of resource allocation between groups, policy 
defini•tion and direction and the power over individuals both within and 
outside ;of •institutions. These conflicts are increasingly pertinent to society 
as a whole as public demands for the accountability of institutions, organisations 
and groups grows. The aurthor concludes by putting forward proposals 
for a partnership strategy for laity and professionals. 

fabian society 

The Fabian Society exists to further socialist education and research. It Is 
affiliated to the 'Labour Party, both nationally and locally, and embraces all 
shades of socialist opinion within its ranks -left, right and centre. 
Since 1884 the Fabian Society has enrolled thoughtful socialists who are 
prepared to discuss the essential questions of democratic socialism and 
relate them to practical plans for building socialism in a changing world. 
Beyond this the Society has no collective policy. It puts forward no resolutions 
of a political character. The Society's members are active in their 
Labour parties, trade unions and co-operatives. They are representative 
of the labour movement, practical people concerned to study and discuss 
problems that matter. 

The Society is organised nationally and locally. The national Society, 
directed by an elected Executive Committee, publishes pamphlets and 
holds schools and conferences of many kinds. local Societies-there are 
one hundred of them-are self governing and are lively centres of discussion 
and also undertake research. 

March 1981 
Cover design by Dick Leadbetter Printed by Civic •Press Limited (TU) , 
Civic Street, Glasgow G4 9RH ISBN 7163 0473 12 ISSN 0307 7535