Willing Slaves: How the Overwork Culture is Ruling Our Lives. Madeleine Bunting

are having to cope with much higher levels of behavioural problems and children with special needs (between 1993 and 2003 their proportion nearly doubled from 11.6 per cent to 19.2 per cent in primary schools, and from 9.6 per cent to 16.5 per cent in secondary¹³). In higher education, lecturers can be allocated as little as five minutes to assess a student’s work.

      In other areas of the welfare state such as health, some of the historic methods to contain the intensity of emotional labour are now crumbling. Nowhere is emotional labour more demanding than in a hospital, where issues of life and death generate huge amounts of fear. Doctors developed a form of emotional detachment as part of the professionalisation of their work in the nineteenth century, and usually delegated the emotional labour to female nurses. Part of the impetus behind the highly bureaucratic procedures adopted in the mid-twentieth century was the desire to reduce anxiety levels. Isabel Menzies wrote a groundbreaking paper in 1959 analysing how nurses’ emotions were managed:¹⁴ for example, a single nurse would be allocated a particular task, such as taking temperatures or providing bedpans, for all the patients on a ward, thus reducing continuous one-on-one contact with individual patients with whom close relationships might have developed.

      These methods of emotional management are being dismantled in response to patient pressure for continuity of care. There is a growing insistence on the part of recipients of the service to be treated as individuals rather than as ‘just a number’. In an individualistic society, the consumer wants to be recognised, and for the service to be personalised; he or she wants the emotional interaction they can buy in the private sector. As a result there has been a shift in nursing practices, so that each nurse has a particular responsibility for a small number of patients, and is expected to develop a relationship with them. The consultancy Harding & Yorke has even been called in to do training for the Royal College of Nursing, and has been commissioned to carry out an empathy audit for an NHS hospital prosthetics department.

      Doctors are now expected to communicate sensitively with their patients, and are trained to do so. Old habits of deference and respect for professionals have given way to a new assertiveness. In many cases this is clearly a welcome development, but it can also generate inflated demands which can be difficult to meet: how many times, for example, does a doctor have to explain a complex course of treatment, and to how many relatives?