Navigating Competition And Collaboration: A Labour Process Study Of Nhs Workforce Experiences With Integrated Care Systems

This thesis explores the challenging (indeed, paradoxical) experiences of workers in Northern England as the NHS transitions from Clinical Commissioning Groups (CCGs) to Integrated Care Systems (ICS) in the region. While ICS is officially enshrined as a joint, logical, and fair reform agenda at national level, the heritage of NPM ideology can still be seen in the NHS’s marketisation, performance monitoring, and managerial dominance practices, which affect the relationships of power in local working practices, professional stances, and health system properties. By using Labour Process Theory (LPT) as its main analytical framework, the thesis investigates how NHS staff, clinicians and senior managers manage the contradictions between managerial rationality and professional values, metric-driven governance and relational care, and the competitive and collaborative logics of institutions.The research involves a series of semi-structured interviews and adopts a qualitative, interpretivist approach, in which the employee voice is analysed through the lenses of three overarching themes: Control Dynamics, Collaborative Shift, and Transition Experiences. The findings demonstrate that, although ICS brings new aspirations for integrated care, cross-functional cooperation, and patient-centred practices, such ambitions often conflict with enduring NPM ideology structures, short-term funding, audit culture, and fragmented commissioning. Thus, staff experience adaptation strain, emotional labour, and moral dissonance. The study also illuminates ongoing inequities in funding allocation and service workforce investment across the North of England, with potentially important implications for the ability of ICSs to address structural health disparity.By constructing the ’NPM ideology–ICS Workforce Experience Transition Model’, this thesis provides a framework that connects Labour Process Theory with empirical evidence. The model demonstrates how staff experiences of managerial oversight, surveillance, and collaboration shape morale, resistance, and perceptions of organisational change. It shows that while ICS reforms aim to promote collaboration, their effectiveness is limited if the residual logics of NPM competition, performance pressures, and managerial control remain embedded in practice. The findings highlight a need to foster cultures of trust, supportive leadership, and a stronger moral economy in healthcare, rather than just focusing on redesigning structures. These insights are particularly relevant for policymakers, NHS leaders, and reformers who seek to make collaborative models such as ICS more sustainable and inclusive.