Integrating care systems and the changing eco-systems of health and care work

Justin Waring, Simon Bishop, Jenelle Clarke and Bridget Roe

Chapter 9 in Research Handbook on the Sociology of the Professions, 2025, pp 125-140 from Edward Elgar Publishing

Abstract: Many developed health and social care systems are currently facing a workforce crisis, prompting calls for new roles, improved teamwork, and enhanced integrated working. Focusing on the reconfiguration of health and care service in England, this chapter examines how the introduction of integrated care systems is impacting the social organisation of health and care professions. Informed by Abbott's eco-system perspective, the chapter describes how three broad groupings of health and care professionals experience integration efforts in different ways. Marginal entrepreneurs represent relatively low status occupations and experience integration as an opportunity to either consolidate or expand jurisdiction. Consolidating elites experience integration as an opportunity to cement and deepen their dominant position. The squeezed middle experience a challenge and loss of jurisdiction from the opportunities presented to others, as more complex tasks are moved to specialists and less complex tasks are acquired by marginal entrepreneurs. The chapter suggests claims to jurisdiction are based on both access to specialist resources and technologies, and also proximity to or membership in certain communities. These claims play out through different forms of boundary work, through forming of new alliances, actively questioning and challenging claims, and making deals to create opportunities.

Keywords: Health and care; Integration; Elites; Eco-system; England (search for similar items in EconPapers)
Date: 2025
ISBN: 9781035323074
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