Employment Restructuring in the Health Service: Efficiency Initiatives, Working Patterns and Workforce Composition

Abstract

The evidence which has accumulated regarding the impact of contracting-out and the implementation of measures designed to increase `efficiency' in NHS domestic ancillary services suggests that the circumstances of the jobs concerned have sharply deteriorated. But what are the repercussions of this process, in which employment opportunities have been radically restructured, on the profile of the workforce itself? Have there been any significant changes in the workforce composition as a result of the changes in working conditions and employment opportunities? The research presented in this paper suggests that with the restructuring of domestic ancillary employment, in particular, the increased reliance on part-time work, the profile of the workforce has changed significantly. Existing studies investigating the dynamics of the `flexibility drive' and of job degradation, however, have essentially ignored these questions, and instead have largely conceptualized the problem in a way that accords primacy to economic variables and `demand-side' factors. In contrast, the research presented here suggests that the primary significance of so-called `background' characteristics of incumbents must be recognized in order to more fully understand the dynamics of the flexibility drive and the nature of employment restructuring.