In order to refine our understanding of professional autonomy, we need to consider it in the context of the NHS as a politicised, marketised and bureaucratised organisational hierarchy. Needless to say it is structurally complex, in the extreme. Many stakeholders, and agents seeking to collaborate and compete for scarce resources. That’s how it is and likely to remain: complex. The mix of a) complexity, b) conflicting strategies and c) multiplicity of priorities and challenges, usual spell ‘trouble’ from a System’s perspective. Policy makers’ narratives about the NHS may not necessarily reflect the actual lived experiences of people working within the system or its service users. In my experience of working in the NHS, the policy makers have always celebrated the potential contribution the AHPs/Therapists would be able to make to the development of the our healthcare system.
But, we need to analyse political rhetoric about the potential role of therapists and evaluate what it actually means on the ground, at the coal-face so to speak. Local realities may not reflect the intension behind the national healthcare policy rhetoric. In some cases there may be a significant disconnect with national policy and local implementation. And positive messages from the professional body (CSP) may difficult to implement locally due to the prevailing power-dynamics, politics and priorities, locally. “Pro-active physiotherapists are vital to NHS plans” (Frontline 6/7/16, p11). Indeed they always have been.
Together with one of my colleagues we set up a countywide ESP service in 2000, from scratch. We steered and implemented the project from planning to execution. In today’s healthcare ‘market’ (in England) that scenario would be inconceivable, because most (if not all) of the items for negotiation and decision making needed get the service up and running would be negotiated more centrally at commissioning level in accordance with their perceived priorities and within their financial planning framework.
Any definition or description of PA should focus primarily on its most vital component: being empowered. Now, the eagle focuses, from a long distance on what is essential to achieve their immediate objective; catching their pray. Achieving this is not the actual aim; survival of their species is. You may wonder what the relevance of this analogy is?