Changes in the Ministry of Health in the UK


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On January 12th, 2016, nearly 4,000 operations across England were cancelled as more than 30,000 junior doctors took part in the first 24-hour strike within the NHS in 40 years (O. Wright, 2016). This was to be the first of many walkouts over the next few months by junior doctors in the UK, with two nine-hour strikes of over 21,000 doctors on April 27th and 28th coming as the latest blows to the NHS (Triggle, 2016). The impetus for the striking? Junior doctors were protesting proposed amendments to employment contracts put forward by the Ministry of Health that would, amongst other things, curtail what constitute unsocial working hours: Basic pay rates on weekdays (Monday – Friday) would be extended from 7:00 pm to 9:00 pm; and daytime work hours (7:00 am – 5:00 pm) on Saturdays would be reclassified as basic pay rate hours. In a public statement released on the same day, The British Medical Association – the union representing over 153,000 doctors – cited growing levels of exhaustion and burnout amongst its junior doctors brought on by overwork during nonstandard hours and days, issues that would only be exacerbated by the proposed changes. As one representative put it, “In part, this dispute is a symptom of frustration and low morale that has been building for decades and the strain that a career in medicine can place on your work-life balance” (O. Wright, 2016).

The proposed changes to what constitute unsocial work hours put forward by the Ministry of Health are reflective of broader efforts being made in many industries throughout the UK and the rest of Europe to extend the range of services offered 24 hours a day and 7 days a week. Indeed, firms throughout most post-industrial societies are increasingly expanding their hours of operation outside of the traditional Monday to Friday, 9:00 am to 5:00 pm workweek to increase competitiveness and provide continuous operation. Such trends, as Delsen, Bauer, Cette, and Smith (2009) observe, are part of a broader decoupling between individual working hours and firm operating hours as more people are being employed at staggered times to cover greater expanses of the day. While jobs entailing night, evening, and weekend hours were once primarily concentrated in the industrial and health sectors, we have witnessed an expansion of these schedules to a growing number of subsectors and occupational categories. Recent Labour Force Survey estimates indicate that now around 17% of employed Europeans work regular evenings (6:00 pm-10:00 pm), 6% work regular nights (10:00 pm-6:00 am), and between 14-25% work regularly on Saturdays and/or Sundays (Eurostat, 2016).

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How did these high levels of nonstandard work schedules come about? Paid employment during weekends, nights and evenings is no new phenomenon. As Presser (2003) notes, it has been around at least as long as midwives have been employed for childbirth, an event that can occur at any hour. Similarly, policies promoting work during nights and evenings date back to Roman times, when Augustus Caesar restricted city deliveries of goods by horse-drawn vehicles to night hours to reduce daytime congestion (Scherrer, 1981). More recently, the industrial revolution of the 19th century saw the growth of large urban centers, a shift to more complex divisions of labour under Fordism, as well as the advent of artificial lighting; these factors both facilitated and necessitated the shift to round-the-clock economic activity (Presser, 2003; Scherrer, 1981). Since then, employment in night, evening, and weekend hours have been core features of many occupations, including nursing, protective services, transport, and manufacturing.

However, a confluence of interconnected secular economic, demographic and technological trends occurring since around the 1950s have led to the spread of these schedules to a more varied array of jobs. Perhaps the most prominent of these factors has been the staggering growth of the service sector – what Presser (2003) calls, the 24/7 economy – which now accounts for roughly 72% of all jobs in Europe and explains much of the rise in nonstandard schedules (ILO, 2018; Presser, Gornick, & Parasher, 2008). A core feature of the service sector that distinguishes it from other sectors is the absence of a physical product that can be stockpiled. For this reason, the production of services is inextricably linked to their consumption, and in many cases, the two processes must occur contemporaneously (Bauer & Groß, 2009). As consumer demand for services increasingly spills outside of the traditional 9:00 am to 5:00 pm, Monday to Friday workweek, this means that more and more workers are required to sell their labour during nonstandard hours and days.

The growing demand for services during nonstandard hours and days is in part driven by the increased labour force participation of women during daytime hours and the concomitant decline in full-time homemaking; this has led to, amongst other things, an increased desire for restaurant and other food services in the evenings as well as the need to extend shop opening hours (Presser, 2003). It is also, as Wight, Raley, and Bianchi (2008) note, in part driven by the delaying of marriage and parenthood, which has increased the numbers of young adults without parental and spousal obligations who seek recreation and entertainment opportunities later in the evening and at weekends. On top of this, the growth in real wages over the past few decades has increased the amount of disposable income individuals and families can spend on services outside of work (Mills, 2004). Employers in the service sector are increasingly forced to meet this new demand by staffing more workers during evenings, nights, and at weekends. This is perhaps compounded by the proliferation of information and communication technologies, which has meant that workers can, in theory, be ‘on call’ at all hours of the day (Winkler, Mason, Laska, Christoph, & Neumark-Sztainer, 2018).

While one could argue that firms have always been incentivized to extend their hours of operation to maximize productivity, it is also important to note that they have never been as free as they are now to do so. Over the past 30 years, countries throughout most of Europe have made large pushes towards the deregulation of labour markets to combat unemployment and keep up with global competition (Philp, Slater, & Wheatley, 2014; Rubery, Smith, & Fagan, 1998). A new emphasis on promoting functional and temporal flexibility for firms means that employers have growing power to adjust not only the number of hours individuals work in accordance with demand but also when these hours are worked (Mills, 2004; Presser, 1998). Moreover, as Chatzitheochari and Arber (2009) note, the continuing erosion of working time regulations and declining representation from unions in the negotiation of working conditions have turned working time into a private arrangement made between employees and employers rather than a matter to be settled through governmental policies or collective agreements. This has meant that throughout Europe the primary determinant of the duration and location of paid work hours is increasingly the market rather than a State-defined workweek.

It should be noted, however, that nonstandard work schedules can also represent a choice on the part of the employee. Indeed, an important supply-side factor in the rise of the 24/7 economy has been the growing labour force participation of women and increase in dual-earner households, who increasingly turn to nonstandard schedules as a means of work-care reconciliation (Begall, Mills, & Ganzeboom, 2015; Carriero, Ghysels, & van Klaveren, 2009; Mills & Täht, 2012). For example, in what’s been termed, tag-team parenting (Presser, 2003) or off-scheduling (Lesnard, 2008), nonstandard work schedules can allow parents to desynchronize their work hours to be able to each cover caregiving responsibilities during different periods of the day. Nonstandard schedules also tend to concentrate amongst the rising numbers of self-employed workers like freelancers and independent contractors, especially those in the so-called, gig economy. Freed from managerial constraints, this growing segment of the labour force typically benefits from greater time sovereignty and flexibility, making it relatively free to align the quantity and timing of paid work hours with personal preference rather than a normatively-defined work week (Gold & Mustafa, 2013; Kunda & Barley, 2004; Lombard, 2001; Osnowitz & Henson, 2016; Shevchuk, Strebkov, & Davis, 2018). It has even been suggested that the desire for flexible, atypical working times may influence the decision to enter into self-employment in the first place, particularly for those with dependent care responsibilities (Lombard, 2001).

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