Sketches From a Sociologist’s Career: 24 – Sociology in the Fractured Society

Despite numerous suggestive remarks, some of them uncompromising, I have not directly confronted the circumstances facing sociologists and sociological practice in the rentier capitalism of the 21^st century. Anyone who has been with me from the start of this series of epistles will have noted the enormous changes that have impacted academia in general and sociology in particular since I joined my career path in 1972. Relaying my experiences in London University’s medical schools has born testimony to this. In this sketch I pull a few threads together. Unsurprisingly perhaps, I refer most often to medical sociology and to sociological theory. I also superficially draw on a paper co-authored with Alice Scavarda and Sasha Scambler and presently awaiting an editorial verdict (from the journal I helped found in 2003, Social Theory and Health).

Life has incontrovertibly got tougher for sociologists pursuing a career in higher education. I have already noted my relative unproductivity compared with my successors at UCL, Paul Higgs and Fiona Stevenson; and I was without doubt myself more productive than my predecessors. How many of the sociologists teaching at Surrey University when I was an undergrad would today be appointable to equivalent posts? This is not to criticise them, or for that matter my own cohort. But it is to raise the issue of the criteria according to which putative bars have been raised. Certainly the ‘dead wood’ has long since gone from universities, and there indeed was some. Now, to replace the dead wood we have a plethora of temporary, insecure and often underpaid posts that suit management far more than the workers. It has become normal not only for undergrad ‘paying customers’ to scan fields for credentials that promise decent salaries, but for postgrads and post-docs to have to sprint before they have learned to jog. Universities, like the society in which they are nestled, are fractured. They are essentially neoliberal regimes of precarity, oriented no longer to education but to the system imperatives of the job market.

Remembering Bourdieu once more, universities might be said to constitute ‘fields’, arenas of struggle in which different types of capital – economic, cultural, social and symbolic – might be employed and deployed. But, critically, the ‘field of power’ (politics) is core and intrusive, structuring the university as with all other fields. How does this play out? It is an opportunity to pull some threads from prior sketches together. I do so with primary reference to those areas in which my own efforts have been concentrated, namely, social theory and health. Universities, to reiterate, have morphed into neoliberal institutions. They are now, as literary critic Stefan Collini, writing in the London Review of Books in 2018, argued: ‘forced to regard each other as competitors in the same market, where flourishing will be dependent on the accuracy with which they pitch their products to their particular niche of consumers.’ UCL, like other elite Russell Group universities, is relatively well placed, most other institutions of higher education less so. The TINA-dictated ideology of neoliberalism has turned many senior management and administrative teams into its representatives, teaching and research staff into its practitioners and students into clients or consumers. Added to this, there is growing evidence that the Conservative government is instigating a general system of rewards and punishments designed to undermine and kill off many courses in arts, humanities and social sciences as superfluous to the capitalist ‘imperative to work’ (whilst doubtless sparing Oxbridge and other elite institutions from this vandalism).

Mention had repeatedly made to contemporary precarity. Employmees in universities share the characteristics of many other stressed and depressed members of the so-called ‘precariat’. Moreover, academic ‘tenants’ forced into time-limited posts are frequently required to demonstrate high levels of productivity whilst planning for their next career move. Ph.D students must scrupulously tick institutional boxes and give and publish papers even as they proactively contrive curricula vitae in anticipation of … well, what exactly? In our paper submitted to Social Theory and Health, we coin the term ‘proactive manoeuvering’, which typically involves a reflexive mix of demonstrable productivity, networking and multiple job applications. And all this in an era of unnerving uncertainty and volatility.

Tony Giddens writes in his Consequences of Modernity, published in 1990, of the compression of time and place. In line with this, sociological careers in rentier capitalism are severely time-constrained and monitored, calling for improvised decision-making on-the-hop. Time is oriented to the ‘now’, a trend that impacts not only on Ph.D students and early career short-term contract researchers but extends also to leading peer review journals, editors, and many reviewers prioritising new or recent over older references. It is as if algorithms rule over common sense (another example of Ritzer’s ‘irrationality of the rational’). Older references according to this way of thinking suggest scholarly tardiness or simply being out of touch or trapped in the past. One entirely predictable result is that wheels are constantly being reinvented. This has the effect of distorting empirical investigations and reportage and theoretical input alike. It is a distortion exacerbated by the longer-term tendency within sociology to split empirical and philosophical-cum-theoretical thinking and outputs into discrete categories, neither one informing the other.

This often-institutionalised division of labour between theory and empirical research – remember, I was told my chances of being promoted to professor at UCL would be simplified/increased if I presented as a theoretician rather than as some sort of catch-all or hybrid sociologist – has been further compounded during the unfolding of rentier capitalism by new forms of specialisation. In the theoretical domain this has led to the virtual abandonment by the mainstream discipline of studies engaging with and representing women, people from racial and ethnic minorities, people with disabilities, those with non-heterosexual preferences, and so on. Sections of the British Sociological Association have become progressively detached and independent, often critiquing mainstream sociology in the process. But, as we argue on our paper, theoretical specialisation has gone beyond the generation of autonomous discourses in third or fourth waves of feminism, post-colonial, disability and sexuality studies. Within the parent discipline as well as among its rebellious offspring, divisions have become more pronounced, as is reflected in the number of new highly specialised peer review journals. A by-product of this hyper-specialisation is a growing detachment from sociology’s canonical theoretical core. As we put it: ‘together with the bathwater of the largely male, white, European sociological canon, featuring Marx, Durkheim, Weber and on and off a handful of select others, which did indeed require ‘deparochialising’, has gone the baby of a family of macro-social issues around social order and change.’

I need not say more about the ubiquity of hierarchical metrics, which I have denounced in a previous sketch, but a further word or two about what have been called the ‘cultural turn’ and ‘normative sociology’ are in order. The postmodernisation or relativisation of culture, featuring the collapse of Lyotard’s grand in favour of his petitnarratives, the foregrounding of concepts like post-truth and cancel culture, plus the emergence of identity politics, has opened the door to a plethora of imaginative paradigms and theories. I have often described these processes as more akin to the disinhibition induced by excess alcohol consumption than to genuine forms of emancipation; but they have had the effect of easing the path of many a novel specialisation. As for normativity, or ‘normative sociology’, a case might perhaps be made for its hiving off to become yet another specialised output, semi-detached (at best) from the sociological mainstream. But it is regarded as institutionally suspect by many sociologists let alone by university employers. On this point, a paper I co-authored commending ‘muckraking sociology’ on political/public health governance in relation to COVID was rejected out of hand by the leading UK journal, Sociology, as ‘polemical’. To develop this point, it is helpful to revisit my ideal types of ‘six sociologies’.

I have long argued both for foresight and action sociology to be appended to Troy Burawoy’s original quartet, and for these two additions to be part and parcel of what it is to ‘do sociology’ in the twenty-first century. As Ruth Levitas, expert on utopian studies, has shown in her excellent Utopia as Method, they were once deemed intrinsic to the discipline but have since been nudged aside. My view is that Burawoy’s four types of sociology are undoubtedly important components of the discipline; but what is the point of sociology if it is entirely focused on presence to the exclusion of absence, on what is to the exclusion of what might have been and might yet be? It is an issue I shall return to when introducing a manifesto for a social transformation. What I want to emphasise here is that the sociological community-as-a-whole, not of course each and every sociologist, should embrace a foresight sociology oriented to possible ‘alternative futures’, and an action sociology that ‘fights back’ when findings of the discipline, say on Conservative corruption around COVID, the calculated undermining of the NHS, deepening health inequalities or the weaponizing of stigma to remove benefits from recipients redefined as abject, are neglected, ignored or rubbished by advocates of – usually nowadays, but not always – right-wing neoliberal agendas.

Forgive the detail in the example that follows! Consider the continuing assault on the NHS. It is incontrovertibly the case that the NHS, while not without its faults (what health care system is?) was before Margaret Thatcher started tampering with it in the 1980s with a view to involving the private sector, something of a model of health care delivery. All the international evidence said, and says, keep private providers and markets away from clinical and allied health services. What Thatcher began was to gather momentum. Major’s principal contribution was to introduce Private Finance Initiatives (PFIs), an attractive proposition for government because private contractors rather than the government paid for new hospitals and other facilities, afterwards leasing them back to health care Trusts, often at extortionate rates. PFIs enjoyed a massive boost under Blair/Brown’s New Labour. The problem, pointed out at the time by Allyson Pollock and others, was that Trusts would eventually find paying for PFI facilities all but untenable. Indeed, the chickens have long since come home to roost. But while Blair/Brown improved funding for the NHS in real terms, this all changed after 2010 when the Cameron’s Conservative coalition government introduced ‘political austerity’, systematically underfunded the NHS and looked with increasing sympathy towards the private sector. Chomsky has spelled out a very familiar neoliberal strategy: first you underfund a public body like the NHS, which leads to an increase in public dissatisfaction with services, then you send in the for-profit cavalry to save the day. The short-lived regimes of Theresa May, Boris Johnson, the hapless Liz Truss and Rishi Sunak have all sought to implement and foster this same strategy.

The results at the time of writing are already clear. The Health and Social Care Act of 2012 left the door ajar for private providers. I remember asking a Dean at UCL if organising a public protest against it when it was at the Bill stage would count as a positive public engagement, but he just looked confused. The Health and Social Care Act of 2022 opened the door further. This is not the place to go into the details of this second Act, but it is worth dwelling for a moment on one aspect of the growing private provision of health care ‘under the NHS brand’. Operose was formed early in 2020 when the American company Centene Corporation brought together its UK subsidiaries, The Practice Group (TPC) and Simply Health. TPC had been acquired by Centene in 2016. In January 2020 Centene had increased its stake in UK-based health care by investing in Circle Care (a 40% stake according to Company House). In February 2021 Operose Health acquired AT Medics and its various GP surgery contracts in London. Previously owned by six GP directors, AT Medics had been operating 49 GP practices across 19 London boroughs, providing services for around 370,000 people, with 900 employees. AT Medics was taken over and its directors resigned to be replaced by Samantha Jones, CEO of Operose, ex-head of NHS England’s new care models programme and previously chief executive of Epsom and St Hellier University Hospitals and West Hertfordshire Hospitals Trust, Nick Harding, Director of Operose and formerly Senior Medical Adviser to NHS England for Integrated Care Systems and Right Care, and Edward McKensie-Boyle, Chief Financial Officer of Operose. See a pattern here?

There are historical links to be made. Under the auspices of ‘modernisation’, ‘partnership working’ and ‘patient/consumer choice’, neo-Thatcherite New Labour had actively encouraged initiatives like AT Medics, which was set up in 2004. The six founding ‘doctorpreneurs’ won several contracts under conditions allowing GPs and their companies to run publicly funded GP surgeries and to employ doctors. Patients did not pay fees, but ‘GP Consortia’ companies could profit from public NHS funds to run GP surgeries. So it was in fact New Labour who pioneered new business models that the Conservatives went on to develop post-2010 and refine post-2020.

To return to Operose. In June of 2022 the Operose website listed contracts for 20 GP surgeries, plus one treatment centre in Birmingham (and nine ophthalmology clinics). The same website also listed the contract for AT Medics to provide the out-of-hours services for all of Croydon and some of the South-West London Clinical Assessment Service. With the addition of the AT Medics contracts, the company will have 69 GP surgeries and become the largest GP surgery network in the UK. A BBC Panorama programme shown on 13 June 2022 drew on the research of an undercover reporter, who found that Operose employs less qualified – cheaper – US-style Physician Assistants (PAs) to see patients and that they were inadequately supervised. Reports from admin staff confirmed that some correspondence had not been processed and seen by a GP or pharmacist for up to six months. The undercover journalist working as a receptionist at one of the London GP surgeries quoted a GP as saying that they were short of eight doctors, and that the practice manager had confirmed that they hired less qualified PAs because they were cheaper.

This case study is important for two reasons. First, it confirms that the NHS is indeed being privatised by stealth. And second, I believe it fortifies my argument in favour of pro-normative, foresight and, especially, action sociology. The journalists who exposed the profiteering activities of Operose might be seen as successors to the noted muckraking journalists in the USA in the 1960s. It was British journalists too who probed the corruption, comfortably beyond ‘chumocracy’ or ‘cronyism’, around Conservative-placed COVID contracts, a story that Benny Goodman, Miranda Scambler and I tried and failed to tell in two leading sociology journals (though we have a chapter in Fran Collyer’s forthcoming edited collection, Research Handbook for the Sociology of Knowledge). It seems to me that we sociologists have a responsibility not only to conduct professional and policy research into these matters, as scholars and reformists respectively, but also to re-engage with the tradition of muckraking sociology and campaign to effect change, as activists. To remain passive is to sanction rentier capitalism’s neoliberal status quo. For such endeavours to be dismissed as ‘polemics’ says a lot about the state of sociology in the UK.