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Local trade union responses in the context of public healthcare service privatisation

Local trade union responses in the context of public healthcare service privatisation

Coderre-Lapalme, Genevieve (2018) Local trade union responses in the context of public healthcare service privatisation. PhD thesis, University of Greenwich.

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Abstract

Both in France and in England, ‘New Public Management’ (NPM) mechanisms such as privatisation, marketisation and decentralisation have been an integral part of healthcare reforms, aiming to improve efficiency and cut costs (Bach and Bordogna, 2011). In response, some trade unions have looked to influence the implementation of these reforms by politicising healthcare service delivery in an attempt to stop privatisation (Krachler and Greer 2015). Yet, comparative research focused on NPM reforms has tended to either ignore or underplay the role of organised labour in shaping policy implementation.

To address this gap, this thesis explores the ways which NPM inspired healthcare reforms are implemented in different national contexts and the factors that shape local trade union responses to this. Drawing on Kelly’s (1998) mobilisation theory, it proposes a framework which links two typologies of collective identity (Hyman 2001a; Kelly 1996) to trade union strategic choice via two core framing processes: diagnostic framing and prognostic framing (Snow and Benford 2000), allowing for a more in depth look at the mechanisms which shape trade union responses to privatisation.

This research adopts a cross-national comparative case study design to explore national and local dynamics. A total of six cases are compared, with three located in England and three located in France. A multi-method approach is used, combining 31 semi-structured interviews with key informants and documentation as evidence. A majority of cases were found to have resulted in private sector involvement being abandoned; in England, all three cases services remained within the NHS while only one of the French cases resulted in private sector involvement being stopped. Where unions adopted a ‘strategic mobilisation’ rather than a ‘co-determination’ approach, privatisation was more likely to be abated.

The findings of this research suggest that trade union identity and core framing tasks are especially important in guiding strategic choice. These variables help to explain why, irrespective of the national and local context, case study unions responded differently to healthcare privatisation. Although national institutional frameworks and decision-maker strategies can limit trade union participation in decision-making, this research demonstrates that structural factors can constrain but do not determine trade union strategic choice as strategy implementation is found to be dependent on access to internal and external resource. Ultimately, with strong resources, trade unions can overcome the obstacles in their environment and shape case outcomes.

Item Type: Thesis (PhD)
Uncontrolled Keywords: Healthcare reforms; privatisation; new public management (NPM); trade unions;
Subjects: H Social Sciences > H Social Sciences (General)
Faculty / Department / Research Group: Faculty of Business
Faculty of Business > Department of Human Resources & Organisational Behaviour
Last Modified: 31 May 2019 14:11
Selected for GREAT 2016: None
Selected for GREAT 2017: None
Selected for GREAT 2018: None
Selected for GREAT 2019: None
URI: http://gala.gre.ac.uk/id/eprint/24534

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