Introduction

The National Health Service (NHS) is the largest employer in Europe, employing in the region of 1.3 million health workers across the primary and secondary care sectors and the community. Nurses are the largest group of health workers, accounting for 440,000, the absolute size of this group alone making them a key component of the healthcare labour process (DH, 2005). This chapter focuses specifically on the nursing labour process. Our overall aim is primarily analytical, to explain and evaluate the various ways in which control is exercised by management over nursing labour, its inherent limits and the possibilities this provides for resistance by nurses to the central dynamics of the nursing labour process. In support of this analysis we call on data from our own ‘research’. Clearly, the nursing labour process is shaped intimately by the overall organisational context of the healthcare industry, which, in the UK, has witnessed considerable turbulence and growing instability marked by a shift towards the market. Therefore the chapter begins with a brief overview of these changes since they constitute a primary determinant for managerial controls for healthcare labour. We conclude that the unstable transition to the market is the precondition for understanding the complex, overlapping, management strategies to enforce control over the nursing labour process. These involve an uneven hybrid of managerial controls drawing from Taylorism, new public management (NPM) and the moral management of professional autonomy. Each strategy, whether taken alone or combined, has thus far failed and, in light of the wider contradiction thrown up by the capitalist labour process, will continue to fail in its objective to comprehensively control nursing labour power.

The NHS and the nursing labour process in context

Up until the end of the 1970s and notwithstanding charges for prescriptions, dentistry and optical services, the market played no fundamental role in the running of the NHS. When it came to decisions over human and physical resource allocation the distribution of care was decided by the ‘visible hand’ of the state. Gradually, however, the NHS has undergone a series of changes aiming to bring it closer to the market. The attractions of the market for government are clear enough.