Pay determination for nurses : pay review, grading and training in the 1980s
This thesis develops a policy-oriented account and evaluation of pay determination and associated employment changes for U.K. nursing staff in the 1980s, within an analytical framework for understanding nursing pay processes and outcomes over longer time horizons and with greater generalisability. In particular, an analysis is conducted of the Pay Review Body for Nurses and Midwives and of the interlinkages between pay determination, grading and training at different levels of aggregation. The study is multidisciplinary, employing a wide range of primary documentation, and findings from national-level interviews and local case studies at eight district health authorities in the West Midlands region. The thesis divides into three parts. The first locates nursing pay determination in historical context. Structural characteristics in the health division of labour and in the wider political economy lend a degree of apparent continuity to nursing pay levels. However, this appearance masks important change which must also be understood. The second evaluates the origins of nursing pay review, its processes and outcomes. The conflicting bargaining positions and power relations between the 'Sides' in pay review are noted, together with the continued importance of negotiation and of 'non-pay' issues. The role of the Pay Review Body is considered alongside nursing pay outcomes. Although the Review Body could be seen as contributing to conservative outcomes for nurses' pay, there are complex feedbacks within the system which must also be understood. The third section considers 'non-pay' issues and tne interplay of national and local forces in an evaluation of local managerial perspectives on nurse resourcing and employment changes in the 1980s. It is argued that a 'crisis' occurred in the late 1980s, rooted in history and political economic circumstance, and that the process of pay deceritralisation should be understood in this light. This process, however, is a risky and uncertain one.