Chapter 1: Introducing policy alienation and the power of professionals
Currently, there is an intense debate concerning professionals in the public sector (Ackroyd et al., 2007; Currie et al., 2009; Emery and Gianque, 2003; Hebson et al., 2003). Authors such as Duyvendak et al. (2006) and Freidson (2001) note that many of the pressures that professionals face are related to the difficulties they have with the policies they have to implement. For example, Bottery (1998:40), examining the pressures on professionals stemming from new policies in education and health care in Great Britain, cites a teacher arguing that: The changes have been outrageous, and have produced a culture of meritocracy and high flyers. There’s massive paperwork because the politicians don’t believe teachers are to be trusted. A second example refers to the introduction of a new reimbursement policy (known as Diagnosis Related Groups, DRGs) in Dutch, mental health care. The system of DRGs was developed as a means to determine the level of financial exchange for mental health care provision. This was part of a process to convert the Dutch health care system into one based on a regulated market. The DRG policy differs significantly from the former method, in which each medical action resulted in a financial claim. The old system meant that the more sessions a professional caregiver had with a patient, the more recompense could be claimed. This was considered by some to be very inefficient (Kimberly et al., 2009).