Abstract
From a sociology of work standpoint, one of the noteworthy outcomes of the COVID-19 pandemic has been the extent to which it has increased the visibility of what heretofore was a largely overlooked frontline workforce – support workers in health and social care (Rossiter and Godderis, 2020). This important contribution edited by Mike Saks provides an enlightening insight into the features, structures and challenges facing this diverse and growing cohort of workers. Through a collection of chapters, the book contributes to ongoing debates on the future of healthcare delivery, focusing on the role played by support and nonprofessional staff in different national settings. The central premise of the book is to both fill a major gap in the literature on the role of support workers and their interface with other health professions, and to influence policy and practice in healthcare delivery. The book delivers a varied and balanced mix of theoretical discussion, and empirical case studies. Chapter contributions range from an examination of support and allied health professionals (Nancarrow); to an exploration of the work performed by those in complementary and alternative medicine (Almeida and Barros); to a critical assessment of the role of health support workers in the ageing crisis where Hosoda’s review of the Japanese context gives insight into challenges that will likely become more apparent in western societies in the coming years.
While it is stated that the book is aimed at ‘final year and postgraduate students, academic lecturers/researchers, practitioners and policy makers’ (p. ix), the fields from which that audience might be drawn is diverse. Although the focus of the book is healthcare related, it draws on a variety of themes that would be of interest to researchers in a multitude of fields. For example, Chapter 2 would likely be of particular interest to labour process scholars, depicting as it does the precarious employment status of support workers in both Canada and the UK. Similarly, Chapter 4 discusses the management of support workers, considering the impact that New Public Management (NPM) practices have had on the occupation. The chapter holds a critical lens to the managerialised systems at play in health and social care settings, and the drives for efficiencies that impact workers. The chapter draws on theoretical insights from Foucault’s ‘governmentality’ approach, presenting an alternative model to NPM. NPM is a theme revisited at several junctures throughout the book, as is the issue of professionalisation, a common theme running through many of the chapters. Chapter 3 may be particularly valuable for those interested in gender equality or work–life balance research, because it focuses on informal carers, a group referred to as the ‘shadow workforce’ in healthcare. Intentionally or otherwise, in that chapter, Williams and Lum touch on the fundamental issue of how work is defined. Many of the themes from that chapter are later re-examined in Chapter 10 where the authors examine labour market conditions for personal support workers in Canada. The importance of regulation emerges throughout the book; however, in contrast to more general texts on healthcare, the focus moves beyond the role of regulation from a patient viewpoint, instead bringing to the fore its importance from a labour perspective.
A particularly strong feature of the book is the wealth of empirical data presented. Chapter 7 (Liljegren, Dunér and Olin) tackles a persistent debate on the role of support workers in social care, namely whether they should form part of a service that is managed by staff or by service users themselves. Through two detailed case studies conducted in the Swedish social care system, the chapter illustrates challenges that exist for support workers in residential and domiciliary care settings. It also captures the voices of both support workers and the service users they support. This is an approach that in my view the book would have benefitted more from, since the voices of those deemed to be at the bottom of the professional hierarchy in healthcare are rarely captured and documented.
Taken together, the contributions cover an extensive amount of content. The editor concludes that it is their hope to contribute to driving forward beneficial policy change in health support work. Given recent experience amid the global pandemic that has placed health and social care systems under added pressure, the insight and critical academic thinking contained within this book has the potential to really contribute to policy changes that seek to create a more equal and rewarding working environment for support workers.
