welfare care & Jan Willem Duyvendak is Professor of Sociology at edited by care & the University of Amsterdam, the Netherlands. Jan Willem Duyvendak care & welfare Trudie Knijn is Professor of Interdisciplinary Social Trudie Knijn welfare Science, Utrecht University, the Netherlands. Monique Kremer Monique Kremer is research fellow at the Professional and the New People, Policy, Netherlands Scientific Council for Government Policy. Professionals have been a topic of debate since the nineteen-seventies. One Policy, People, and point of criticism was that professionals were overly focusing on their own interests rather than that of clients. Another was that their expertise was the New Professional overestimated: clients were knowledgeable too. Recently, however, a different sound has been noted: professionals are put under pressure too much. The De-professionalisation and Re-professionalisation emphasis on accountability, marketisation, and demand-led services has in Care and Welfare totally undermined the position of doctors, social workers, and care workers. Policy, People, and the New Professional: De-professionalisation and Re- professionalisation in Care and Welfare clearly shows that the introduction of new policy concepts in various European welfare states, while necessary, has indeed had many perverse effects on the everyday practice of care and welfare. But not all the outcomes are negative. In addition to the processes of de-professionalisation traces re-professionalisation are becoming evident. This fresh and exciting study book addresses key issues faced by welfare professionals, from ‘contract culture’ and evidence-based practice, Duyvendak | Knijn | Kremer (eds.) to dealing with multi-culturalism or fostering ISBN-13 978 90 5356 885 9 neighbourliness. It will be of immense value to ISBN-10 90 5356 885 9 professionals struggling to redefine their role in a changing world; to academics reaching for new theoretical frameworks; and to students of social and public policy. Prof. dr. Janet Newman, Professor of Social Policy at the Open University, UK www.aup.nl A U P A U P AUP_Duyvendak_def.indd 1 17-05-2006 11:13:10 Policy, People, and the New Professional CARE & WELFARE Care and welfare are changing rapidly in contemporary welfare states. The Care & Welfare series publishes studies on changing relationships between citizens and professionals, on care and welfare governance, on identity politics in the context of these welfare state transformations, and on ethical topics. It will inspire the international academic and political debate by developing and reflecting upon theories of (health) care and welfare through detailed national case studies and/or international com- parisons. This series will offer new insights into the interdisciplinary theory of care and welfare and its practices. series editors Jan Willem Duyvendak, University of Amsterdam Trudie Knijn, Utrecht University Monique Kremer, Netherlands Scientific Council for Government Policy (Wetenschappelijke Raad voor het Regeringsbeleid – WRR) Margo Trappenburg, Utrecht University, Erasmus University Rotterdam Policy, People, and the New Professional De-professionalisation and Re-professionalisation in Care and Welfare Jan Willem Duyvendak Trudie Knijn Monique Kremer (eds.) In memory of Eliot Freidson (1923-2005), whose work has been a great in- spiration for this book. This publication has been made possible with the financial support of the Dutch Ministry of Health, Welfare and Sport, the Netherlands Orga- nisation for Scientific Research, Royal Netherlands Academy of Arts and Sciences, the Netherlands Institute of Care and Welfare/Department of Social Policy, Verwey-Jonker Institute, The Amsterdam School for Social Science Research/University of Amsterdam and the Department of In- terdisciplinary Social Science/Utrecht University. Cover illustration: © Sake Rijpkema/Hollandse Hoogte May 2005: Ouder Kind Centrum (OKC), Amsterdam, the Netherlands. This centre is a collaboration of various partners, including accou- cheuses, maternity care, Municipal Health Services, health centres, and child welfare organisations services. Boy being examined by a doctor, while his mother and sister watch. Cover design: Sabine Mannel/NEON Design, Amsterdam Lay-out: JAPES, Amsterdam ISBN-13 978 90 5356 885 9 ISBN-10 90 5356 885 9 NUR 740 © Amsterdam University Press, Amsterdam 2006 All rights reserved. Without limiting the rights under copyright reserved above, no part of this book may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording or otherwise) without the written permission of both the copyright owner and the author of the book. Table of Contents 1. Policy, People, and the New Professional 7 An Introduction Jan Willem Duyvendak, Trudie Knijn and Monique Kremer PART I POLICY 2. The Rise of Contractualisation in Public Services 19 Trudie Knijn and Peter Selten 3. Evidence-Based Policy 34 From Answer to Question Giel Hutschemaekers and Bea Tiemens 4. Societal Neurosis in Health Care 48 Margo Trappenburg 5. When Ideologies Bounce Back 64 The Problematic Translation of Post-Multicultural Ideologies and Policies into Professional Practices Jan Willem Duyvendak and Justus Uitermark PART II PEOPLE 6. Safe Neighbourhoods 81 Sophie Body-Gendrot 7. When Diversity Matters 97 Marleen van der Haar 8. From Residents to Neighbours 109 The Making of Active Citizens in Antwerp, Belgium Maarten Loopmans 9. Authority, Trust, Knowledge and the Public Good in Disarray 122 Monique Kremer and Evelien Tonkens PART III PROFESSIONALS 10. Heroes of Health Care? 137 Replacing the Medical Profession in the Policy Process in the UK Celia Davies 5 11. Tensions in Medical Work between Patients’ Interests and Administrative and Organisational Constraints 152 Werner Vogd 12. Empowerment of Social Services Professionals 164 Strategies for Professionalisation and Knowledge Development Jeroen Gradener and Marcel Spierts 13. Professional Management of Professionals 181 Hybrid Organisations and Professional Management in Care and Welfare Mirko Noordegraaf About the contributors 194 References 197 Index 217 6 table of contents Policy, People, and the New Professional An Introduction Jan Willem Duyvendak, Trudie Knijn and Monique Kremer In the 1970s and 1980s, scholars were loudly criticising the power and intentions of social professionals. Three decades later, one hears a differ- ent voice, that of professionals whose power, expertise and knowledge are being undermined, which is causing serious problems. During an interview, Bourdieu (1998) said that the right hand of the state does not know what the left hand is doing. In other words, technicians, bureau- crats and policymakers have no clue about the work of those who actu- ally implement public policy, such as teachers, policemen and social workers. As a consequence, the knowledge of what is really going on in society is not shared with decision makers, who in turn do not acknowl- edge the specific character of socio-professional work. They do not dis- tinguish between the logic of the market and professional logic: ‘How can we not see, for example, that the glorification of earnings, productiv- ity, and competitiveness, or just plain profit, tends to undermine the very foundation of functions that depend on a certain professional disinter- estedness often associated with militant devotion?’ (Bourdieu 2002: 183- 184). Bourdieu and other analysts of social policy point out that the role of professionals has been changed – or reduced – as a consequence of the restructuring of welfare states by way of marketisation and accountabil- ity, the redefinition of citizens into consumers, and an accentuation of client participation. New modes of governance have intentionally limited the discretionary space of professionals. Marketisation and the focus on consumer-led services stress the voice of users or consumers at the ex- pense of professionals. Since clients have now gained both voice (by means of legal appeals and by ‘turning organisations upside down’) and exit options (by giving clients vouchers or money to choose their pre- ferred services), professionals have lost autonomy and authority. This makes it difficult to intervene in people’s lives, even when clients may need support (Tonkens 2003). Additionally, the stress on accountability forces professionals to live up to managerial and bureaucratic standards. These new forms of governance have changed the motivation of profes- sionals, their workload and the content of their job (Clarke & Newman 1997; Exworthy & Halford 1999). Rather than behaving like profes- sionals they are led by a new kind of consciousness, ‘a dispersed man- agerial consciousness’, as Clarke and Newman put it. 7 The most striking evidence for the change in climate is the fact that a leading critic of professional power, Eliot Freidson, published in 2001 a book in defence of professionalism, Professionalism: The Third Logic.He describes two dominant logics that have now overruled the logic of pro- fessionalism: bureaucracy and consumerism. What worries Freidson is not so much the restriction of the knowledge monopoly of professionals, but the fact that professionals are no longer supposed to be the moral protectors of this knowledge. If they can no longer decide how and where this knowledge is to be put to use, professionalism itself is at stake. ‘Professionals have a claim of license to balance