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Hollowing out national agreements in the NHS? The case of “Improving Working Lives” under a “Turnaround” plan

Ian Roper (Business School, Middlesex University, London, UK)
David Etherington (Middlesex University, London, UK)
Suzan Lewis (Middlesex University, London, UK)

Employee Relations

ISSN: 0142-5455

Article publication date: 13 February 2017




The purpose of this paper is to consider the resilience of a national-level initiative (Improving Working Lives (IWL)) in the face of local-level initiative (Turnaround) in an NHS hospital and compare to Bach and Kessler’s (2012) model of public service employment relations.


Case study research consisting of 23 in-depth semi-structured interviews from a range of participants.


The principles behind IWL were almost entirely sacrificed in order to meet the financial objectives of Turnaround. This indicates the primacy of localised upstream performance management initiatives over the national-level downstream employee relations initiatives that form the basis of the NHS’ claim to model employer aspiration.

Research limitations/implications

The case study was conducted between 2007 and 2009. While the case study falls under previous government regime, the dualised system of national-level agreements combined with localised performance management – and the continued existence of both Turnaround and IWL – makes the results relevant at the time of writing.


Some studies (e.g. Skinner et al., 2004) indicated a perception that IWL was not trusted by NHS staff. The present study offers reasons as to why this may be the case.



Roper, I., Etherington, D. and Lewis, S. (2017), "Hollowing out national agreements in the NHS? The case of “Improving Working Lives” under a “Turnaround” plan", Employee Relations, Vol. 39 No. 2, pp. 145-159.



Emerald Publishing Limited

Copyright © 2017, Emerald Publishing Limited

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