Precarity amongst service managers in the NHS: a review in the midst of austerity and Brexit

With a national agenda for public service integration and realising the need for a diverse and
resilient NHS workforce, recent political movements in the wake of austerity and Brexit
challenge the very capability of the NHS to achieve this agenda. Health service
professionals (service managers amongst them) in the NHS, who already found themselves
in a state of operating amongst unclear processes, blurred boundaries and expanding
remits, are now also faced with increasing work insecurity in light of recent political
developments. The most crucial macro-level developments that form the context for this
study are Brexit and the recent austerity measures to cut and cap redundancy entitlements
for NHS staff in the UK. Brexit implies much confusion and uncertainly for the NHS and
public services in general across the UK. The implications are potentially large for the
significant number of service managers that widely serve health and social care. This comes
at a time where the NHS in itself faces a staff shortage crisis and where UK Public Service
financing is expected to deteriorate. The paper uses the theory of Precarity to explore the
ways in which service managers in the NHS understand and view precarious employment
and changes in their work as a result of socio-political developments that dominate
organisational change. While Precarity has been a topic of interest in education and how
you can account for it in the modern-day workplace (Vallas, 2015), there has been very little
focus, if any, on examining managers and employment insecurity in the NHS using the lens
of Precarity. Precarious employment, and precarious working, in the NHS are often
overlooked and under studied since the NHS system is one dominated by politically set
targets and managerial efficiency, a complex and shifting structure, a culture where mistakes
are feared by frontline staff and where the nature of work is intangible (Cotton, 2016). From
both an organisational and management perspective, there is a need therefore to better
understand and reduce labour Precarity in public services, particularly the health service
(Farr-Wharton et al., 2015). This study engages with a systematic review of Precarity in the
NHS, taking on the challenge of examining and understanding precarious employment for
managers to date in the context of British healthcare services while focusing on the future
NHS. The systematic review addresses the question: ‘How do service managers in the NHS
understand and view precarity in employment and how do they experience precarious
working during austerity and Brexit’? As an ongoing study, the paper proposes to engage in
cognitive interviews with service managers in NHS England and obtain their views and
experiences about austerity-led and Brexit-fuelled changes. This working paper provides us
with a review of the evidence and enables us to theorise Precarity amongst service
managers in present day NHS and more widely, in UK public services during a challenging
time.