NHS pay determination and work re‐organisation

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Abstract
Examines the reform of NHS employment practices focusing on managerial attempts to alter pay and working practices within NHS Trusts. It draws on case study evidence to illustrate the difficulties that have confronted managers in making radical changes in employment practices. It is argued that, despite important changes in working practices, the possibilities for a more strategic approach towards the management of staff in the NHS remains heavily constrained by central government intervention which reduces management autonomy at Trust level. After considering the implications for NHS employment practices of the NHS reforms, case study evidence from an acute trust hospital of pay determination and work organisation reform is assessed. Concludes by placing these findings in a wider context, including the prospects for employment practice reform under a Labour government.