Skip to main content
×
×
Home

Workforce Responses to the Creeping Privatization of the UK National Health Service1

  • Rebecca Kolins Givan (a1) and Stephen Bach (a2)
Abstract

When the British National Health Service was founded in 1948, professional employees and support staff, with the exception of family doctors, worked directly for the state. Since the 1980s, private employment in the National Health Service (NHS) has steadily grown. Beginning with the outsourcing of support services, the number of privately-employed workers in the National Health Service has gradually increased. This paper argues that marketization in the health sector has increased dramatically under the New Labour government. As policymakers have moved from ideological to pragmatic justifications for marketization, union opposition has similarly become more pragmatic and less ideological. With unions unable to stop these reforms, they have turned to the practical concerns of their members in partially-privatized workplaces under complex employment arrangements. This article shows that while ideologically opposing marketization, unions and employees have been forced into a more pragmatic position. Research at two privately-funded public hospitals shows that unions in the workplace have used their resources to protect their members, as thwarting the involvement of the private sector is nearly impossible.

Copyright
References
Hide All

NOTES

2. This paper does not recap the early history of the NHS and employment therein. For more on these areas, see Clegg, Hugh Armstrong and Chester, Theodore Edward, Wage Policy and the Health Service (Oxford, 1957); and Webster, Charles, The National Health Service: A Political History 2nd ed. (Oxford, 2002).

3. Fischbacher, , Moira, , and Beaumont, P.B., “PFI, Public-Private Partnerships and the Neglected Importance of Process: Stakeholders and the Employment Dimension,” Public Money and Management (July 2003): 171176.

4. Ibid., 174.

5. Grainger, Heidi, “Trade Union Membership 2005,” in Department of Trade and Industry, Employment Market Analysis and Research (London, 2006).

6. Helen Bewley, “Raising the Standard? The Regulation of Employment and Public Sector Employment Policy,” British Journal of Industrial Relations 44:2 (2006).

7. Bach, Stephen and Givan, Rebecca, “Union Responses to Public-Private Partnerships in the National Health Service,” in Trade Unions: Resurgence or Demise?, ed. Fernie, Susan and Metcalf, David (London, 2005).

8. The Information Centre for Health and Social Care, NHS Staff 1995–2005, April 24, 2006. (http://www.ic.nhs.uk/pubs/nhsstaff).

9. Public Administration Select Committee, The Public Service Ethos: Seventh Report of Session 2001–02, Volume 1. (London, 2002); Hebson, Gail, Grimshaw, Damian, and Marchington, Mick, “PPPs and the Changing Public Sector Ethos: Case-Study Evidence from the Health and Local Authority Sectors,” Work Employment Society 17:3 (2003): 481501.

10. Carter, Bob and Fairbrother, Peter, “The Transformation of British Public-Sector Industrial Relations: From ‘Model Employer’ to Marketized Relations,” Historical Studies in Industrial Relations 7 (Spring 1999): 119146.

11. Bach, Stephen and Givan, Rebecca Kolins, “Union responses to public-private partnerships in the National Health Service,” in Trade Unions: Resurgence or Demise?, ed. Fernie, and Metcalf, D. (London, 2005).

12. UNISON, “Unison At Work: Health”: (http://www.unison.org.uk/healthcare/index.asp)

13. Certification Office, Annual Report of the Certification Officer 2001–02 (London, 2002).

14. Ascher, Kate, The Politics of Privatisation: Contracting out Public Services (Basingstoke, 1987), 24.

15. Department of Health and Social Security, “Competitive Tendering in the Provision of Domestic, Catering and Laundry Services” Health Circular 83:18 (1983).

16. NHS Management Inquiry, Department of Health and Social Security, Report of the NHS Management Inquiry (London, 1983).

17. Ascher, The Politics of Privatisation: Contracting out Public Services, 26–29.

18. Bach, Stephen, “NHS Pay Determination and Work Re-Organisation,” Employee Relations 20:6 (1998): 571.

19. Hall, J., A Statement of the Difficulties Experienced by Contractors Working with Government Departments (London, 1986), 1.

20. HM Treasury, Using Private Enterprise in Government: Report of a Multi-Departmental Review of Competitive Tendering and Contracting for Services in Government Departments (London, 1986), Annex D, para. 7.

21. Bach, Stephen, “Competitive Tendering and Contracting Out,” in The NHS/Private Sector Interface, ed. Cook, Haydn (Harlow, 1990).

22. Ascher, The Politics of Privatisation: Contracting out Public Services, 112–14.

23. Trades Union Congress, Contractors' Failures: The Privatisation Experience (London, 1985); Trades Union Congress, The Privatisation Experience: Competitive Tendering for NHS Services (London, 1990).

24. Contract Cleaning and Maintenance Association, The Facts on the NHS Privatisation Experience (London, 1990), 2.

25. A. Dix, “Tender Mercies,” Health Service Journal 23 (May, 1996).

26. Damian Grimshaw, “Changes in Skills-Mix and Pay Determination among the Nursing Workforce in the UK,” Work, Employment and Society 13:2 (June 1999).

27. Bach, Stephen, Employment Relations and the Health Service: The Management of Reforms (London, 2004).

28. D.W. Light, “Managed Competition, Governmentality and Institutional Response in the United Kingdom,” Social Science and Medicine 52:8 (2001).

29. Le Grand, Julian, “The Labour Government and the National Health Service,” Oxford Review of Economic Policy 18:2 (2002): 141.

30. HM Treasury, Public Private Partnerships: The Government's Approach (London, 2000).

31. UNISON, “PFI: Failing Our Future. A Unison Audit of the Private Finance Initiative,” (2002).

32. Alan Milburn, Speech by the Chief Secretary to the Treasury, Alan Milburn MP, at the PFI Transport Conference, HM Treasury (London, 1999).

33. United Kingdom Parliament, House of Commons Hansard Written Answers for 7 March 2006 (Part 1), (London, 2006).

34. Department of Health, “Prioritised Capital Schemes Approved to Go Ahead since May 1997 (England)”: (http://www.dh.gov.uk/assetRoot/04/12/35/73/04123573.pdf).

35. King's Fund, Designing the ‘New’ NHS: Ideas to Make a Supplier Market in Health Care Work (London, 2006), 6.

36. Matthew G. Dunnigan and Allyson M. Pollock, “Downsizing of Acute Inpatient Beds Associated with Private Finance Initiative: Scotland's Case Study,” British Medical Journal 326.26 (April 2003), Damian Grimshaw, Steve Vincent, and Hugh Willmott, “Going Privately: Partnership and Outsourcing in UK Public Services,” Public Administration 80:3 (2002).

37. Grimshaw, Vincent, and Willmott, “Going Privately: Partnership and Outsourcing in UK Public Services,” 476. It is worth noting, that the word partnership may have outlived its usefulness. It is used to refer to union-management partnership, union-government/party partnership (social partnership), and public-private provider partnerships, which may or may not include employee groups. Bach and Givan, “Union Responses to Public-Private Partnerships”; Nicholas Bacon and John Storey, “New Employee Strategies in Britain: Towards Individualism or Partnership?” British Journal of Industrial Relations 38:3 (2000); Badigannavar, Vidu and Kelly, John, “Labour-Management Partnership in the UK Public Sector,” in Union Organization and Activity, ed. Kelly, John and Willman, Paul (London, 2004); Stephen Byers, “Public Private Partnerships and P.F.I” Speech at the Social Market Foundation (London, 2003); Moira Fischbacher and P.B. Beaumont, “PFI, Public-Private Partnerships and the Neglected Importance of Process: Stakeholders and the Employment Dimension,” Public Money and Management (July 2003); Grimshaw, Vincent, and Willmott, “Going Privately: Partnership and Outsourcing in UK Public Services”; Norma Heaton, Bob Mason, and Joe Morgan, “Partnership and Multi-Unionism in the Health Service,” Industrial Relations Journal 33:2 (2002); Edmund Heery, “Partnership Versus Organising: Alternative Futures for British Trade Unionism,” British Journal of Industrial Relations 33:1 (2002), IPPR, Building Better Partnerships: The Final Report of the Commission on Public Private Partnerships (London, 2001); Kelly, John, “Union Militancy and Social Partnership,” in The New Workplace and Trade Unionism, ed. Ackers, Peter, Smith, Chris, and Smith, Paul (London, 1996); Bob Mason, Norma Heaton, and Joe Morgan, “Social Partnership Strategies in Two Health Service Trusts,” Personnel Review 33:6 (2004), Anne Munro, “Working Together—Involving Staff: Partnership Working in the NHS,” Employee Relations 24:3 (2002); Sally Ruane, “A Clear Public Mission? Public-Private Partnerships and the Recommodification of the NHS,” Capital and Class 73 (2001); Stephanie Tailby et al., “Partnership at Work and Worker Participation: An NHS Case Study,” Industrial Relations Journal 35.5 (2004), Michael Terry, “Can ‘Partnership’ Reverse the Decline of British Trade Unions?” Work, Employment and Society 17:3 (2003).

38. Grimshaw, Vincent, and Willmott, “Going Privately: Partnership and Outsourcing in UK Public Services,” 476.

39. Department of Health, The Government's Response to the House of Commons Health Committee's First Report on the Role of the Private Sector in the NHS (London, 2002); Department of Health, Private Finance and Investment, April 24, 2003: (http://www.doh.gov.uk/pfi/schemes1.htm); UNISON, “Carving up the NHS: Private Sector Diagnostic and Treatment Centres,” Pamphlet, London, 2003; UNISON, “PFI: Failing Our Future: A Unison Audit of the Private Finance Initiative” Pamphlet, London, September 2002.

40. Pollock, Allyson M., NHS Plc: The Privatisation of Our Health Care (London, 2004).

41. Atun, Rifat and McKee, Martin, “Is the Private Finance Initiative Dead?,” British Medical Journal 331 (2005): 792.

42. UNISON, “Not So Great: Voices from the Front-Line at the Great Western PFI Hospital in Swindon,” Pamphlet, London, 2003.

43. Interview with author, May 5, 2004.

44. Interview with author, May 28, 2003.

45. Ibid.

46. Interview with author, October 11, 2003.

47. Sarah Hall, “NHS Counts Cost of Hospital Debts,” Norwich Evening News, June 8, 2006.

48. Terry Macalister and John Carvel, “Huge windfall for hospital's PFI investors as staff face job cuts” The Guardian, May 3, 2006.

49. Interview with author, June 28, 2006.

50. Gaffney, Declan et al. , “The Private Finance Initiative: PFI in the NHS—Is There an Economic Case?BMJ 319:7202 (1999): 116.

51. The Audit Commission, Learning the Lessons from Financial Failure in the NHS: Health National Report (London, 2006), 28.

52. Interview with author, May 28, 2003.

53. Lister, John, The Pfi Experience: Voices from the Frontline (London, 2003), 5.

54. Ibid., 7.

55. Interview with author, June 26, 2006.

56. Jo Revill, “Entente Not So Cordiale,” BMJ 324:7348 (2002).

57. Interview with author, May 28, 2003.

58. Lister, The PFI Experience: Voices from the Frontline, 13.

59. Steve Davies, “Hospital Contract Cleaning and Infection Control,” Pamphlet, Unison, London, January 2005.

60. Toynbee, Polly, Hard Work: Life in Low Pay Britain (London, 2003).

61. UNISON Private Contractors Unit, Agenda for Change—Implementation of the Agreement by Private Contractors. Report to Health Care Service Group Executive, February 17, 2005: (http://www.unison.org.uk/acrobat/B1793.pdf).

62. The Labour Party, “Ambitions for Britain: Labour's Manifesto 2001,” Pamphlet, London, 2001, 21.

63. Robert Davies, “Contracting out and the Retention of Employment Model in the National Health Service,” Industrial Law Journal 33:2 (2004).

64. Stephen Bach and David Winchester, “Opting out of Pay Devolution? The Prospects for Local Pay Bargaining in Uk Public Services,” British Journal of Industrial Relations 32:2 (June 1994).

65. King's Fund, “Designing the ‘New’ NHS: Ideas to Make a Supplier Market in Health Care Work,” 41.

66. United Kingdom Parliament, Select Committee on Health, “Evidence Submitted by the Department of Health (Istc 1)” (2006).

67. Department of Health, ISTC Manual (London, 2006).

68. United Kingdom Parliament, Select Committee on Health, “Evidence Submitted by the Department of Health (Istc 1)” (2006).

69. United Kingdom Parliament, Select Committee on Health, “Evidence Submitted by Amicus Health Sector” (2006).

70. United Kingdom Parliament, Select Committee on Health, “Evidence Submitted by the Royal College of Nursing (Istc 22)” (2006).

71. Bach and Givan, “Union Responses to Public-Private Partnerships.”

72. United Kingdom Parliament, Select Committee on Health, “Evidence Submitted by Unison (Istc 42)” (2006).

73. Ibid.

74. Bach and Winchester, “Opting out of Pay Devolution?”

75. United Kingdom Parliament, Select Committee on Health, “Uncorrected Evidence 934,” (2006).

1. The authors would like to thank the Leverhulme Trust for funding for much of this research, which was carried out under the Future of Unions in Modern Britain program at the London School of Economics.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Labor and Working-Class History
  • ISSN: 0147-5479
  • EISSN: 1471-6445
  • URL: /core/journals/international-labor-and-working-class-history
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed