Introduction

In this chapter we shall explore the current debate about the role of support workers in social care – namely, whether they should be part of a service run by staff or users. The focus of the analysis is on two cases. The first is support services in group homes, which can be seen as a provider controlled. The second is personal assistance in domiciliary settings as a user-led service. The relative merits of formal training and the role of support services for disabled people, including people with various chronic health conditions, are discussed against a wider context of user preferences in a situation where, as in other international contexts, politicians are seeking cost savings and hold the key to future developments.

When professions came into the spotlight with authors like Freidson (1970) and Larson (1977), a few top professions like medicine were described and analysed using the metaphor of hierarchy (Liljegren 2016). The focus at that point was on how these top professions act to remain in the upper part of the hierarchy – as, for example, through the use of ‘market shelters’ (Freidson 2001). The neo-Weberian perspective was created as a counter to more naïve perspectives that only highlighted the virtues of professionalism (Saks 2010). The claim on power within society for professions based on credentialism and formal knowledge can be seen as the basis of professional power (Collins 1979; Liljegren et al 2014). In this perspective educational facilities, including universities, are both the producers of formal knowledge and responsible for introducing and socialising new members into the ideology of professions – such that, for example, formal knowledge should be rewarded economically, symbolically and socially.

Within contemporary research on professions there is increased interest in broadening the discussion, taking into account occupational and other groups that are not traditionally cast as professions or semi-professions – including laypersons (Liljegren et al 2017), service users (Eyal 2013) and support workers (Dunér and Olin 2011; Saks 1995; Zagrodney and Saks 2017). These groups might not be defined as professions, but can still be described as having expertise in the sense that they make claims on getting the work done better (Eyal 2013).