Introduction

The major determinants of changes to the pay, terms and conditions of health sector support workers during New Labour's occupation of 10 Downing Street have stemmed from a drive to efficiency savings and the commercialisation of service delivery. The commercialisation of service delivery has included the use of market principles mainly through the contracting process and the privatisation of parts of ‘public’ service delivery. Both of these processes have subjected National Health Service (NHS) support workers, who are the principal focus of this chapter, to competition and to transfer into private sector employment. In health, the specific mechanisms have been the private finance initiative (PFI) and other forms of public–private partnership (PPP). This chapter examines how the PFI procurement process creates pressures on both private consortia and NHS trusts to acquiesce in the depression of terms and conditions of support staff and how those affected have attempted to resist and mitigate these effects.

This chapter draws on accounts of worker experience, notably the qualitative interview data collected in UNISON-commissioned projects, to understand the ‘voice from the frontline’ (Lister, 2003; UNISON, 2003). The extracts from these interviews, which are in the public domain, form part of two documents examining the impact of PFI, one across several hospitals (UNISON, 2003), the other within the context of the Great Western PFI Hospital in Swindon (Lister, 2003). Although the interview materials reflect a partisan stance, offer no guidance relating to the selection and editing of quotations and cannot be taken as comprehensive, they do offer insights into changing work experience and are rich in practical detail and mundane minutiae. The private consortia or companies and the NHS trusts referred to in this chapter are: SERCO at the Norfolk and Norwich NHS Trust; Sodexho at Hereford Hospitals NHS Trust; Haden at the North Durham Health Care NHS Trust (Durham); Criterion at South Durham NHS Trust (Bishop Auckland); ISS at the Hairmyres Hospital, Lanarkshire; Carillion at the Great Western Hospital, Swindon; Interserve at the Cumberland Infirmary, Carlisle; and Consort at the Edinburgh Royal Infirmary.

The main complaints of workers examined concerned wage levels, other financial terms of service, physical and material conditions of work, control of the labour process, ‘belonging’ to the wider NHS team and service quality. Individual and collective responses to these complaints are explored in this chapter.