Reshaping internal labour markets in the National Health Service: new prospects for pay and training for lower skilled service workers?

Abstract

This article considers how two new strategies for improving pay and skills development have been used in the UK National Health Service (NHS) to develop labour capacity and capability by stimulating the development of relatively coherent internal labour markets for workers at the lower end of the occupational hierarchy. Drawing on data from 13 NHS trusts, we scrutinise the implications of the new national pay system, Agenda for Change, for healthcare assistants and cleaners and find substantial one‐off improvements in pay for these groups as a direct result of the new national pay framework. However, the detailed case‐study data reveal there is considerable uncertainty regarding the extent, depth and durability of pay improvements. In particular, opportunities for pay progression in reward for acquisition of new skills and qualifications were more variable as a result of the stronger role of management choice and strategy at the organisational level in implementing the new national strategy for skills development, the Skills Escalator. Moreover, management strategy shaped the demand for, and distribution of, intermediate‐level skills (through new job design, for example), which was critical to the effectiveness of trusts in pulling lower grade employees up through an internal career trajectory.

Solving the Labour Problem Among Professional Workers in the UK Public Sector: Organisation Change and Performance Management

“…She maintained that the Labour government's modernisation agenda, with its demand for increased flexibility, has had major implications for the structure of the public sector workforce, wherein modernisation and cost reduction agendas have led to the increased casualisation of the public sector workforce in a quest to achieve 'numerical flexibility' and to the increased polarity of the workforce into two tiers subject to radically different terms and conditions and experiences of employment. Similar restructuring exercises were reported in relation to nurses and social workers (Cox et al 2008;de Ruyter et al 2008). This, Conley argued, exposes a key contradiction in public sector employment, while the public sector has been at the forefront of diversity and equal opportunities and the quest to create a single status for public sector workers, it has also been in the vanguard of promoting 'flexible forms of working' through the increased casualisation of the workforce, thus demonstrating the dissonance between the rhetoric and the reality of modernisation.…”

Disaggregating and reaggregating work: Workers, management and the struggle over creating coherency and purpose in a context of work degradation

“…Indeed, Cox et al () investigated the possibilities, and constraints against, public sector attempts to become such a ‘model employer’. This was through a study of the NHS and ‘Agenda for Change’ and ‘Skills Escalator’ initiatives which were introduced to improve pay rates and skill development for lower skilled workers, including cleaners.…”

International Recruitment of Health Workers

“…In many European countries, there have been trends towards decentralization and marketization, with important implications for employment relations (4,5). For instance, reorganization in the UK increased managerial prerogatives and thereby employees' uncertainty with regard to their pay, job definitions and career progression (6).…”

“…Realising that among the causes of these up-and downswings in international recruitment is poor workforce planning, the British government has made increased efforts in this direction, foreseeing increasing demand (26,6). The UK had also encountered the ethical issues Among the most recent employment policies in the British health sector there are the extension of the nurses' mandate to include more medical tasks and the increased use of healthcare assistants, which correspond to the 'deskilling of medicine' scenario.…”