Health Service Reform and the Modernization of Employment Relations: The Case of the United Kingdom

Abstract

There can be few organizations whose restructuring has been as controversial and as subject to so much media scrutiny as the reforms of the National Health Service (NHS) over the last twenty years. Health service reform is not confined to the UK; across all continents governments are struggling to reconcile increased patient expectations with the reluctance of employers and employees to contribute more resources to maintain the growth of health services. The distinctiveness of the UK experience, however, is the degree to which health sector reform has formed a central component of the domestic political agenda for more than two decades. This reform process has altered employment relations but there is uncertainty about the consequences for employees, employers and trade unions. In the health service the degree to which the market-style reforms of Conservative governments and the modernization agenda of the Labour government has transformed employment relations has been a source of controversy. During the 1990s, Conservative government ministers suggested that their reforms were leading to staff working to higher performance standards; managers had acquired the autonomy and influence to establish their own organizational employment practices, without hindrance from trade unions or interventionist governments.