Introduction

There has been a noticeable withdrawal of local authority, hospital trust and in-house funding support for higher-level, clinical and specialist training. Yet most professions now recognise that learning and professional development are lifelong, to be acquired with the aid of continuing professional development programmes (CPD). Led by the Royal College of Nursing, the British Medical Association, the Royal College of General Practitioners and the Patients Association, a coalition of more than 20 charities, medical and professional bodies, and trade unions released an open letter to Prime Minister David Cameron in June 2016, saying that moves to drop funding for student nurses and midwives represented an ‘untested gamble’ (Johnston, 2016). The proposals included stopping bursaries to support nurses during their training and switching them to student loans. Previously, nursing training had been treated differently from other higher and further education courses precisely to help reverse the shortages. The organisations highlighted the ‘worrying lack of clarity or consultation about the effect that funding changes could have on those who need to train for more advanced or specialist roles, such as health visitors or district nurses’ (RCN, 2016b; The Telegraph, 2019). Simultaneously, an RCN survey pointed to a dramatic fall in the number of school nurses, with almost a third working unpaid overtime every day to keep up with their workload. The research showed the number of school nursing posts had fallen by 10 per cent since 2010, leaving 2,700 school nurses now caring for more than 9 million pupils, despite a rising incidence in issues, especially in mental health among children (McVeigh, 2016).

De-professionalisation as a market-led critique of social work training

De-professionalisation may be demonstrated through the trajectory of a political economy model of delivering public services, where, for example, education policy has been progressively shaped by the needs or demands of a market economy. It aims to cut employers’ costs and leads to the gradual marketisation of all services. Such a model comes close to the theory of elite control, in which the National Health Service (NHS) can be thought of as the product of conflict and power struggles between a political and a medical elite and arguably will remain so in the light of policy changes brought about by the Health and Social Care Act 2012 (see, for example, Greer et al 2016: 3–26).