This research explores the state of health service trade unionism in the 1980' s and considers its prospects for the future. This is located within the context of trade unionism in general and more specifically within the public services. Historically trade unions have reflected the contours of capitalist work organisations and the social relations within them. The review of British trade unionism in the 1980's therefore considers the impact of institutional factors together with broader social processes upon unions and the "models" of union behaviour which have emerged. The development of trade unionism in the health service is examined to consider how far it can be understood in similar terms. It proceeds from a review of work organisation and management in the NHS which is used to identify a continuing emphasis by the State on cost-containment in the form of efficiency gains. Attempts to introduce greater "rationality" in bureaucratic forms have confronted the influence of the medical profession in the locally negotiated order. However, more recent changes can be presented as introducing more market-oriented criteria. The possible implications of this new environment for health service trade unionism are considered. A single Health Authority case study is used to examine the types of opportunities which may be created for alternative models of trade unionism, described in terms of bargaining, professionalising and campaigning. Following some general information on the Health Authority and its context, six selected episodes are used to consider the application of alternative strategies. Each illustrates contradictory pressures to which unions may be subject. Finally, the analytical questions on the relationship of public service work to capitalist work organisation, and the consequences for trade unionism are reconsidered.