| Abstract: | This article examines the role of trade unions in the health service at workplace level under the Labour government's modernisation agenda, and focuses on the shifting balance between forms of direct and indirect participation drawing on case studies of three acute hospital trusts. There has been a strong growth in forms of direct communication within the case study trusts and some increase in direct participation among professional groups. Despite this ‘dualism’ in employment relations, however, the target culture of the NHS has precluded the development of effective voice mechanisms. The policy implications for trade unions and the implications for the implementation of NHS pay modernisation are considered. |
