Introduction

Following the theoretical themes of this book, this chapter primarily adopts a neo-Weberian approach to the analysis of health support workers. Health support workers are seen here, as throughout the volume, as paid frontline carers providing support to clients and their carers who are not qualified and registered as part of a profession (Manthorpe and Martineau 2008). The chapter starts by considering the notion of health professionalisation from a neo-Weberian viewpoint, which has brought with it considerable benefits for doctors and others based on a monopolistic position in the market in terms of income, status and power. More recently, though, there has been some debate about deprofessionalisation in a world in which the rewards of professions are often seen to have been diminished by various changing socio-political circumstances. For neo-Marxists this equates to proletarianisation linked to the labour process in capitalist development which is in turn related to membership of the precariat (Han 2018). In this sense, both of these perspectives have a bearing on the relative positioning of health support workers and their precarity or otherwise. They therefore merit initial consideration as they threaten to muddy the water in understanding the socioeconomic situation of this occupational group.

Health support workers by definition do not fit the neo-Weberian notion of professions, but they are groups, as will be seen, whose conditions of work can very often be described as immiserated, even in comparison with those occupations at the bottom of the health professional pecking order and in relation to the proletariat in classic Marxist writing. It is on such health support workers that this chapter focuses – critically considering whether they can be seen as members of the precariat, which neo-Marxists sometimes believe has replaced the proletariat in terms of system-changing class consciousness within capitalism, or simply exist in a comparatively precarious position in the market from a neo-Weberian perspective. This discussion particularly centres on the comparative cases of Canada and the UK – in the latter case focused largely on England given the variations in each of the UK's four countries resulting from their increasingly devolved political authority. The chapter concludes by examining the policy implications of the analysis from the viewpoint of the theoretical concept of precarity.