Front-line Hospital Workers and Inequalities: Social Processes, Racism and Career Development

The subjects of this chapter are front-line workers, whether they are nurses, canteen workers, care workers or porters. These workers are essential to the everyday running of hospitals and the health sector and the well-being of patients, yet the praises particularly of low-paid workers are rarely sung. On the contrary despite the essential work they undertake, they are frequently invisible and undervalued and have a lower status than the medical professionals discussed in Chapters 5 and 6. From those chapters it was evident that hierarchies in hospitals are entrenched, moreover, each level has its own processes of exclusion and discrimination reflecting the institutionalized and highly refined status hierarchies which characterize health care institutions. This is well illustrated in the social relations between physicians and secretaries in the American context. Gordon describes the way that social distance and differentials are normalized and reproduced through status signals, which range from who eats lunch with whom to forms of address, and in everyday social discourse (2005). Such status distinctions are also characteristics of the NHS. Moreover, it is also the case that these hierarchies and their associated social processes may be both racialized and gendered.