New Labour, Modernisation and the Medical Labour Process

“and Mulcahy 1996, Harrison 2002, Rosenthal 1995).”

“Dominent d’abord les réformes du NHS en Grande-Bretagne qui ont donné lieu à de multiples analyses (Allsop, 2006 ; Currie et al., 2009 ; Dent, 2003 ; Harrison, 2002 ; Harrison et Pollitt, 1994 ; Moran, 2000 ; Morrell, 2006).”

“At the individual level, PROMs feedback for detection and monitoring of patients’ problems can be seen as an attempt to modify clinical judgement with encoded, standardised knowledge as part of the move towards scientific-bureaucratic medicine.(22) The intention of increasing patient involvement in the consultation be…”

“and that the imposition of external guidelines will result in a “Fordist” or production line approach to clinical practice.”

“Countering claims the NPM represents a shift towards postbureaucracy, Harrison (2002) asserts that medical practice is becoming increasingly bureaucratic in nature as the profession must seek to legitimize its role within the context of radical consumerism, enhanced perceptions of risk and…”

“reforms. Where the rise of evidence-based medicine, for example, has seen a centralization of power and a scientific logic that has been little resisted by the medical profession ( Harrison, 2002 ), state calls for public participation seem more ambivalent in character.”

“A wide range of public services have experienced modernization, including local government (Pratchett 2002; Wilson 2003; Cochrane 2004), health (Harrison 2002), welfare services (Humphrey 2003; Lewis 2005), public libraries (Newman and McKee 2005) and environmental planning (Blowers 2002).”

“As Harrison (2010) argues, we should not underestimate the capacity of policy to reframe the subjectivities of health professionals and others, and the potential advantages conferred by the role of „leader‟, both material and symbolic, may make it a difficult discourse to resist, despite its definitional imprecision a…”

“Hasegawa et al. (2005) report the results of a survey of all GPs in Scotland, in which 87 per cent agreed with the statement that ‘a holistic approach’ was important in providing good-quality primary care, whilst GPs studied by Sanders and Harrison (2008) used the notion of holism to distinguish their role from that o…”

“Most recently, top–down demands for restructuring have intensified with the establishment of central performance targets (for health, education and social care), league tables and even threats of direct intervention (or special measures) in the case of ‘failing services’ (Cutler and Waine, 2000; Harrison, 2002).”

“generally, however, while the experimental trial has a special place in the hearts of many doctors and while its epistemological foundations resonate strongly with the rationalist, “evidence-based” ideology that pervades contemporary policymaking (Greenhalgh and Russell 2009; Harrison 2002), few researchers with a bac…”

“The development of clinical specialism through GPSI, combined with other factors, such as government priority for a primary care led NHS outlined above, potentially means decisions, previously in the hands of hospital consultants, might now lie in the hands of GPs (Harrison, 2002).”

“Harrison (2002), for example, has explicitly located this in a shift to post-Fordist modes of work organization, while others have seen in it elements of a more fundamental diminution of professional power and authority (Barnett et al., 1998).”

“Indeed it appears, as Harrison [30] argues, to utilize factory like (Fordist) approaches consequently producing some of the negative outcomes described in relation to production line work.”

“This is particularly significant given the current need for systematic, theoretically informed studies of the applicability of researchbased knowledge to routine clinical practice [7,8].”

“…(e.g. Grimshaw et al. 2002); New Public Management and the control of the professions (e.g. Clarke and Newman 1997; Clarke et al. 2000; Flynn 2002; Harrison 2002); analysis of radical versus ‘sedimented’change in the context of the NHS (McNulty and Ferlie 2004); and the discursive practices of…”

“Head and shoulders above the rest, the reforms of the British NHS (National Health System) have been abundantly analyzed (Allsop, 2006; Currie et al., 2009; Dent, 2003; Harrison, 2002; Harrison and Pollitt, 1994; Moran, 2000; Morrell, 2006).”

“the collection and public release of performance data) and close monitoring of this performance towards nationally set targets.(164)”

“Modernization in this context does not rest on technological innovations or on infrastructural investment, although these may be included, but on techniques and social technologies of governance (Harrison 2002:465).”

“Implied is a weakening of professional power to unilaterally control the evaluation of care, the nature and volume of tasks and – with moves to promote, evidence-based, ‘scientific bureaucratic medicine’ (Conrad, 2005; Harrison, 2002) – the process of diagnosis and treatment itself.”

“But, as Steve Harrison (2002) has pointed out, rhetoric is not the same as ‘mere rhetoric’.”

“This move towards a more scientific-bureaucratic form of clinical practice (Harrison, 2002) has, therefore, sought to remove elements of uncertainty and variability associated with the craftsman-type model (Harrison and Smith, 2004) – in seeking to mitigate perceptions of risk associated with this.”

“Harrison (2002) argues that the process of modernisation in the service was similarly founded in “scientificbureaucratic” values, that privilege randomised controlled trials and independently observed, rather than patient experienced, measures.”

“The growth of the ‘audit society’ (Power, 1997) is argued to have led to the development of regulatory cultures and new forms of bureaucracy within medicine which prioritise codified knowledge (Harrison, 2002; Flynn, 2004) such that being a doctor relies more on the production and use of encoded and formal knowledge r…”

“(Harrison 2002).”

“…0277-9536/© 2017 Published by Elsevier Ltd. probabilistic risk, have been highly influential at health policy level, contributing to the codification of research into evidence-based guidelines and often termed ‘scientific-bureaucratic medicine’ (Harrison, 2002).”

“…line with risk logics involves reconfiguring hierarchy and accountability (Noordegraaf, 2011), where Fordist standardisations of professional work (Harrison, 2002), reconfigurations of blame (Douglas, 1992; Warner, 2006) and a related intensification of (self-)surveillance (Deetz, 1997; Fournier,…”

“Three relevant features of these developments can be identified ( Harrison, 2002”

“There are studies of the labor process amongst social workers (Harris 2006), teachers (Carter and Stevenson 2005 and lecturers in further (Avis 2005) and higher education (Mather et al. 2007) as well as of nurses (O’Brien 2007) and doctors ( Harrison 2002 ).”

“For professional workers in health and social care such automation is less likely, although there is evidence that they sometimes perceive ICT in the workplace as undermining their expertise (Harrison, 2002; Haynes, 2003; Henwood and Hart, 2003; Nettleton and Burrows, 2003; Stam et al., 2004).”

“…caution in accepting the one-size fits all approach inherent in a medical–political climate which strives to derive clinical decisions and guidelines exclusively from within the positivist defines of evidence-base (Berg, 1997; Hadjistavropoulos et al., 2000; Haldorsen et al., 2002; Harrison, 2002).”

“…however critically examined, is the primary source of valid knowledge” while insisting that if knowledge is to be considered as valid and reliable, it has “to be obtained from the accumulation of research conducted by experts according to strict scientific criteria” (S. Harrison, 2002, p. 469).”

“Furthermore, health services in recent decades have been pushed towards an ever more scientific-bureaucratic form of medicine (Harrison 2002).”

“What matters, New Labour has consistently argued, is whether the end result works (see, for example, Lister, 2001 or Harrison, 2002 for two accounts of this approach in different social policy fields).”

“…and head teachers) have been accused of centralizing power through the overemphasis of hierarchical responsibility, increasing scientific measuring/monitoring of work performance and removing opportunities for worker initiative (Harrison, 2002; Lawler & Bilson, 2010; Taylor, 1964; Weber, 1947).”

“The first is the increasing shift towards the scientific bureaucratisation of medicine (Harrison, 2002) and the resulting threat to the autonomy of professional groups to make decisions.”

“…and context’ of this article, recent managerial agendas introduced from 1990s and onwards are shown to have had consequences for the medical labour process and for physicians’ identity feelings (Harrison, 2002; McKinlay and Marceau, 2002; Nettleton et al., 2008; Potter and McKinlay, 2005).”

“Indeed, New Labour set up ‘the most systematic strategy for controlling doctors ever attempted in the NHS’ (Harrison 2002 as cited in Bach 2004, p. 61) by developing national standards, treatment guidelines and an inspection agency2 during the late 1990s.”

“Second, there is also a stress on cost cutting and effective resource usage encouraged by the New Public Management (NPM) ideology (Harrison, 2002).”

“1996), UK health policy has largely taken the form of ‘scientific bureaucratic medicine’ (Harrison 2002), in which clinical care is increasingly governed by close adherence to formal guidelines, with clinicians and patients exercising little or no choice (beyond basic consent to treatment) over decisions about therape…”

“…JSP, 31(3): 441-463 84 5.7 194 UK Mixed Child care UK Castles 2003, JESP, 13(3): 207-229 83 6.4 395 UK Quantit ative Family policy Compar ative Harrison 2002, JSP, 31(3): 465-485 81 5.7 156 UK Concept ual Health Medical labour process UK Jessop 1999, SP&A, 33(4): 348-359 81 4.7 368 UK Concept…”

“In the private sector, with varying degrees of success, governmental action created new competition and fuelled broader processes of reorganization and innovation; whilst in the public sector, where liberalization was not viable or politically acceptable, market dynamics where injected by proxy through the development…”