A study of contemporary professionalism within the smaller healthcare professions and the influence of neoliberalist ideology in the age of austerity

The economic recession in 2008 prompted governments across the globe to respond to the rising financial deficit (HM Treasury, 2015). Governments implemented so-called 'austerity measures,' a term used to describe unfavourable economic conditions which aim to decrease the deficit through reduced public expenditure, increased taxation and financial hardship (Mooney, 2015; The Economist, 2015; Stuckler et al., 2017). Inevitably, the health sector has been charged with attempts to control and reduce expenditure (Klein, 2016; Stuckler et al., 2017). The subsequent impact on healthcare provision include reduced access to services, unmet healthcare need, deterioration in mental health, poorer management of long term health conditions and worsening quality of care (Ifanti et al., 2013; Molina-Mula and De Pedro-Gómez, 2013; Karanikolos et al., 2015; Stuckler et al., 2017).

The effect that austere circumstances and fiscal hardship have on the healthcare professions has been explored to a lesser extent. The social and financial impact on staff includes jobs losses, pay cuts, increased workload and stress (Pownall, 2013; Palese et al., 2014). However, the impact of such circumstances on the professionalism of the healthcare occupations is unknown. In a study carried out by the applicant (Tucker, 2017), issues with reconciling occupational and organisational
professionalism, and the impact of austerity and neoliberalist ideology in the healthcare environment were identified; the findings were conceptualised and discussed in relation to Evett's (2003; 2011; 2013) characterisation of the ideal types of occupational and organisational professionalism. Tucker (2017) highlighted the personal, professional and ethical conflict healthcare professions are reconciling daily. This materialised through re-construction of professional identity and division of labour, increased managerialism and business mindedness were mandated, and tasks previously associated with qualified staff, were delegated to assistants. This raises the question of whether such professions are being 'de-professionalised' as a result of the increasing prevalence of neoliberalist ideology and organisational professionalism in the health sector.

If doctors can use their power and hierarchy to operationalise a redefinition of professionalism when challenged by neoliberal control; can the same be said for professions like physiotherapy, who are arguably still defining their professionalism? Are these smaller professions at greater risk of de-professionalisation, rather than redefinition, as their professionalism is yet to achieve the position of authority that medicine enjoys?

Smaller professions size, status and position in the marketplace offers a potential vulnerability to its professionalism and sustained usage of its services; particularly if not seen as 'crucial' to delivery. There is evidence to suggest that this is the case, with the physiotherapists professional body, The Chartered Society of Physiotherapy (CSP) having previously encouraged physiotherapists to fight for services and emphasises the importance of demonstrating effectiveness and value in the healthcare market to avoid decommissioning and loss of services (CSP, 2007; Priestly, 2011).

An organisational ethnography is proposed to examine contemporary professionalism within the smaller healthcare professions, using physiotherapy as a case study. How this profession reacts and responds to organisational challenges will be explored, using austerity as a case example.