Debating the division of labour in healthcare in France and England

As Larson (1990) states, professions are historically specific and ‘there is no pattern of social closure around an occupation that is not inflected by the latter’s past, its specific activity and typical context of performance or…the political context in which closure is obtained.’ Larson’s work focuses particularly on the differences between the establishment of professions in France, where there was considerable state intervention, with that in the US and UK, both of which were more market-oriented. This paper is based on data from an evaluation of a large European exchange programme of staff between Kent and Lille, from 2005 to 2008 and discusses the division of labour in healthcare between two occupational groups, medicine and nursing, in England and in France. This division of labour has been extensively discussed in the UK, particularly since from the mid 1990s the nursing role has been extended and innovations such as nurse prescribing have been introduced, whereas such extended roles have not been introduced in France. The paper draws particularly on interview data from mental health practitioners, in which it is argued that whilst the English nurses may on the surface seem to have a wider range of competences and autonomy, in reality they are more constrained, as they operate under protocols and therefore do not exercise professional judgement. Not only do these data illustrate the centrality of professional judgement in discussions about practice, they also demonstrate the circularity of many debates on extended roles.

Fostering 'habits of reflection, independent study and free inquiry': an analysis of the short-lived phenomenon of General/Liberal Studies in English vocational education and training

In 1957, 12 years after the end of World War II, the Ministry of Education issued Circular 323 to promote the development of an element of ‘liberal studies’ in courses offered by technical and further education (FE) colleges in England. This was perceived to be in some ways a peculiar or uncharacteristic development. However, it lasted over 20 years, during which time most students on courses in FE colleges participated in what were termed General or Liberal Studies classes that complemented and/or contrasted with the technical content of their vocational programmes. By the end of the 1970s, these classes had changed in character, moving away from the concept of a ‘liberal education’ towards a prescribed diet of ‘communication studies’. The steady decline in apprenticeship numbers from the late 1960s onwards accelerated in the late 1970s, resulting in a new type of student (the state-funded ‘trainee’) into colleges whose curriculum would be prescribed by the Manpower Services Commission. This paper examines the Ministry’s thinking and charts the rise and fall of a curriculum phenomenon that became immortalised in the ‘Wilt’ novels of Tom Sharpe. The paper argues that the Ministry of Education’s concerns half a century ago are still relevant now, particularly as fresh calls are being made to raise the leaving age from compulsory education to 18, and in light of attempts in England to develop new vocational diplomas for full-time students in schools and colleges.