Reshaping internal labour markets in the National Health Service: new prospects for pay and training for lower skilled service workers?

This article considers how two new strategies for improving pay and skills development have been used in the UK National Health Service (NHS) to develop labour capacity and capability by stimulating the development of relatively coherent internal labour markets for workers at the lower end of the occupational hierarchy. Drawing on data from 13 NHS trusts, we scrutinise the implications of the new national pay system, Agenda for Change, for healthcare assistants and cleaners and find substantial one‐off improvements in pay for these groups as a direct result of the new national pay framework. However, the detailed case‐study data reveal there is considerable uncertainty regarding the extent, depth and durability of pay improvements. In particular, opportunities for pay progression in reward for acquisition of new skills and qualifications were more variable as a result of the stronger role of management choice and strategy at the organisational level in implementing the new national strategy for skills development, the Skills Escalator. Moreover, management strategy shaped the demand for, and distribution of, intermediate‐level skills (through new job design, for example), which was critical to the effectiveness of trusts in pulling lower grade employees up through an internal career trajectory.