Managing health care assistants? The frontier of control in NHS modernization and skill-mix strategies?

NHS modernization aims to make hospitals more flexible, modern and private sector like for patients by cheapening the costs of nursing care and re-allocating these distributive gains internally at the workplace. Based on sixty interviews and structured questionnaires completed by in one NHS Trust this study asks three research questions. First, how do HCA’s experience modernization where the frontier of control has moved decisively in favour of management? Second, how do locally contingent approaches to HCA’s and equally contingent resistance strategies provide organizational context to workplace control regimes? Third, are absence and job satisfaction understood as resistance strategies which structure antagonism within NHS modernization? Absence appears as a form of resistance to work intensification and associated management demands but is tolerated because it does not formally threaten the managerial prerogative. HCA’s retain intrinsic job satisfaction by marginalizing aspects of their role particularly hands-off patient care and secure distributive gains by imposing this loss on those they seek to help. At the macro level HCA’s retain intrinsic job satisfaction in a contractual approach where they dissociate use of absence from its effects on patients and colleagues