Medicine and Nursing

Professions in a Changing Health Service

The NHS is the largest employer in Western Europe. It embraces two of the oldest professions - doctors and nurses - whose work practices are still highly traditional and yet currently at the forefront of radical change as health work is being reorganized to reflect the new political priorities of the 1990s. This book focuses on the collaborative work of doctors and nurses in one particular area: the acute hospital ward, looking at the effects of `new wave' management on formerly independent, autonomous teams. The authors examine the impact of changes in health service on professional boundaries and inter-professional relations, exploring the paradox of the ostensible drive to decentralise responsibility introduced alongside the increased management of professionals. They discuss the tensions between simultaneous application of Fordist to post-Fordist modes of governance and describe an increasingly fragmented service, in which inflexible working patterns are generated by demand for the optimal use of labour, but where there remain examples of effective collaborative working.