Introduction

Support workers in health and social care increasingly cover a wide range of activities which can include patients and clients’ selfmanagement, through voluntary and family care support networks (Jeffries et al 2015; Milligan 2018). This is in addition to paid support workers within the private as well as public sectors, the former playing a particularly large role in the provision of care homes for the elderly. While support work covers a whole range of activities in these sectors and associated domains, including in private family settings, attention in this chapter will be restricted to institutionalised contexts within health and social care including hospitals, clinics, care homes and residential homes. It is here that problems of management and leadership have been most strongly identified and attempts made to address them. In terms of terminology, as in the rest of the volume, ‘support work’ and ‘support workers’ will be used as a generic term covering both the health and social care sectors, while explicit differentiation will be made between the specific categories of support work in health care and social care where necessary in the text.

This chapter will focus on the following key developments, particularly as they relate to the issues of the management and leadership of support workers based on a neo-Weberian approach to professions and professionalisation:

• • The New Public Management (NPM) and the professional upgrading/reorientation of nursing and the reinvention of support workers.

• • The initial implications and further consequences of this trend for support workers and their management.

• • The shift from the NPM towards the New Public Governance (NPG) and a leadership approach as a means of resolving the challenges of controlling and coordinating support workers.

• • The question of the putative professionalisation of support workers, given the changing dynamics of professionalism and professionalisation in the public and private sector.

The chapter will predominantly focus on developments related to nursing in the UK as an exemplar. It will also draw on evidence from across the European continent to elaborate on various points and to ensure the account is not too myopically Anglo-centric.