73 Closing words

Post-professionalism may be seen as a good or bad thing, depending on one’s perspective. We know, for instance, that resilient societies thrive when they have the resources to fend for themselves and do not have to rely on ‘imported’ expertise (see Chapter 3 and the concept of alienation). And, in many societies, professionals are in such short supply that ‘the expertise of a very few’, is only available to a small minority of people in society, often resulting in a ‘Rolls-Royce service for the well-heeled minority, while everyone else is walking’ ^[1]. So moving away from a reliance on an elite cadre of specialists and experts, and building more ‘local’ support systems may well be a very important thing in the future.

But there is no doubt that for the professionals whose services are being de-centred, post-professionalism represents a worrying trend. Few professionals actively support moves to open up their field to others, preferring instead to fight changes and resist the disruption. And some have expressed concern that undermining the status of medicine and its allies through sociological critique, bureaucratisation, and digital disruption, may have the ‘unintended consequence of damaging positive aspects of the wider role that medical practitioners have carried out in the past’ ^[2].

Transformations in other sectors, however, suggest that change often happens with a striking disregard for the concerns and feelings of those with the most to lose from the disruption. Sometimes the change can come swiftly, sweeping through industries and social services like coal mining, manufacturing, publishing, and accountancy, reshaping the landscape with the speed and ferocity of a sandstorm. At other times the change happens more slowly; a ‘long-fuse, big bang’ ^[3]. Either way, there are no fields or social domains into which professionals penetrate today that has not already been touched by at least some disruption. And, no matter how strong their grip, as the pace of social change accelerates, professionals will be increasingly flung centrifugally to the peripheries.

Terry Johnson suggested in the 1990s that ‘the heyday of professionalism’ was at an end ^[4]. And that competition, bureaucratisation, technological advances, division of labour, the routinisation of work, mounting public scepticism, planning blight, service failures, the perceived dangers of science, ecological disasters, increasing access to higher education, and the rise of critical social consciousness, had resulted in a ‘pronounced shift in public opinion that undoubtedly strengthened the resolve of the governments… to confront the professions’ (ibid).

Indeed, ’There is a strong sense’, Daniel and Richard Susskind argue, ‘that the professions, as currently organized, are approaching the end of an era — in the work that they do, in the identities of the providers of service, and in the nature of the service that they deliver’. ‘We are’, they suggest ‘advancing into a post-professional society’ ^[5].

Having said this, health and education have, thus far, remained reasonably well insulated from the kinds of profound disruption seen elsewhere. Evidence suggests that the authority of individual practitioners remains high, and ‘despite much discussion of the loss of faith in the ‘grand narrative’ of science, medical knowledge and technology retain a legitimacy that outweighs intermittent crises ^[6]. Valerie Fournier has suggested that we may have been too quick, in the past, to pronounce the death of the professions, ‘with little consideration as to what went into the making of the professions in the first place’ ^[7].

Even as late adopters, though, there is little doubt that ‘revolutionary progression into the post-professional society’ ^[8] is taking place, and there is now ample evidence that we are experiencing a cultural shift in the nature of health and healthcare to rival anything that has gone before.