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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.

Purpose: In this chapter, we examine the National Health Service (NHS) and Adult Social Care (ASC) in England, focussing on policies that have been introduced since 2000 and considering the challenges that providers face in their quest to provide a high standard and affordable health service in the near future.

Methodology/Approach: We discuss recent policy developments and published analysis covering innovations within major aspects of health care (primary, secondary and tertiary) and ASC, before considering future challenges faced by providers in England, highlighted by a 2017 UK Parliament Select Committee.

Findings: The NHS and ASC system have experienced tightening budgets and serious financial pressure, with historically low real-terms growth in health funding from central government and local authorities. Policymakers have tried to overcome these challenges with several policy innovations, but many still remain. With large-scale investment and reform, there is potential for the health and social care system to evolve into a modern service capable of dealing with the needs of an ageing population. However, if these challenges are not met, then it is set to continue struggling with a lack of appropriate facilities, an overstretched staff and a system not entirely appropriate for its patients.

The management of human resources is of crucial importance in enabling the delivery of efficient and effective services. The purpose of this paper is to explore one issue relevant to Human Resource Management, that is, the management of hospital doctors in the NHS. The present‐day UK National Health Service faces countless challenges at both the macro and operational level.

The paper examines the implications for the NHS in general, and the medical profession in particular, of the continued dominance of the medical profession over the career management of hospital doctors.

The paper argues that HRM must play a pivotal role in the management of clinicians to ensure the effective and efficient delivery of NHS reforms. The challenges to HRM and the medical profession that are inherent in this process are outlined.

It is argued that the potential long‐term gains to be derived from the development of closer working relationships between human resource managers and medical managers are crucial for the delivery of an effective health service.

A new and innovative way of looking at the management of doctors and their careers within a changing NHS.

This special “Anbar Abstracts” issue of Journal of Management in Medicine is split into 6 sections covering abstracts under the following headings: General Management; Personnel and Training; Quality in Health Care; Health Care Marketing; Financial Management; and Information Technology.

The purpose of this paper is, for English acute NHS hospitals, to investigate how they operate their governance systems in the area of secondary care contracting and identify the key determinants of relationship building within the contacting/commissioning of secondary care focusing upon non‐price competitive behaviour.

A survey instrument was designed and mailed to a sample of all acute NHS hospitals in England of whom 35 per cent responded. This survey was then analysed using logit techniques.

The analysis suggests that: those NHS Trusts offering volume discounts, non‐price competitive incentives or having a strong belief in performance being by “payment by results” criteria are significantly more likely to offer augmented services to secondary care purchasers over and above contractual minima; those NHS Trusts strongly believing in the importance of non‐price factors (such as contract augmentation or quality) in the contracting process are more likely to offer customisation of generic services; and those NHS Trusts using cost‐sharing agreements to realign contracts when negotiating contracts or who strongly believe in the importance of service augmentation in strengthening relationships, or that increased hospital efficiency is the most important aspect of recent NHS reform are more likely to utilise default measures to help realign contracts.

This paper fills a gap in the area of non‐price competition in English NHS acute secondary care contracting.

The National Health Service is key to Britain’s welfare state, and has been subject to repeated reform initiatives. Such reforms rarely “fix” the problems for which they are introduced, but evaluations have neglected the significance of local action. Reform implementation involves local translation of politically contextualized ideas into workable practice. I focus on implementation processes and the role of professions. Ethnographic data reveal local actors engaging with policy objectives to protect existing structures within the boundaries of official reform rhetoric. Actors employ multiple strategies to maintain existing systems. Rather than “failing,” policy is made through localized collaboration.

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.

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.

The planning and implementation of electronic information systems and technology (IS/IT) following the National Health Service (NHS) reforms in the UK are both widespread and significant. Considers these new organizational arrangements, for primary care general practitioners (GPs), to aid decisions for the referral of patients to hospital specialists. The proposals, through an analyses of the concept of markets and hierarchies, may result in an alternative and better referral experience for those patients who express a preference. Presents an overview of the reforms and notes the subsequent impact of IS/IT as a facilitator for changing the structure of primary care within the NHS. Argues that, if primary care physicians adopt a more appropriate management of IS/IT and are proactive in its application, then the outcome will produce more patient choice, less non‐attendance and consequently improved health care provision.

In the mid 1990s the NHS “did” competition, in the mid 2000s the NHS is “doing” choice. This paper aims to cut through the rhetoric, highlight the differences and parallels between then and now and identify if these differences will have a different or the same impact on local services.

Following a review of literature from the 1990s, a qualitative research study is used to examine the impact of competition and markets in the 1990s. The discussion examines the implications of this study for current system reform.

Patient choice recreates many of the features of the internal market, but despite concerns at the time, the internal market did not have a significant impact on services. It is likely that patient choice will similarly have a limited impact.

The research is a case study confined to Day Surgery in one part of the North of England.

The paper reminds academics and practitioners what happened last time the NHS attempted to introduce a market‐based system.

The purpose of this research is to examine the issues of decentralisation in the NHS.

Evidence was gathered from an empirical study in order to illustrate the effect of policy reform on relationships at both the central and the local level. In this paper issues were examined in the context of two reforms at the heart of the decentralisation agenda in the English NHS: earned autonomy and the introduction of foundation hospitals.

Past and current policy in the NHS reflects elements of both centralisation and decentralisation. The tension created by such opposing forces has an impact not only on inter‐organisational partnership working but also on the balance of power within local health economies.

Attempts to control the NHS exhibit unresolved contradictions and tensions. This research showed that the challenge for policymakers, managers and clinicians is to manage such tensions.