Professional roles and the commercialization of hospital services: A case study of medical laboratory scientists

Abstract

In the last twenty years, the NHS has been undergoing great changes. There have been moves towards what may be termed, the commercialization of the service, originating from the general management movement of the Griffith's Report (1983), privatisation moves and the more recent 'internal market reforms of the NHS and Community Care Act (1990). The implementation of these changes has pervaded all parts of the NHS, challenging the work of professional groups, as they work within a constantly changing environment.

This case study focuses on one such group, medical laboratory scientific officers (MLSO's, now known as biomedical scientists) who work in pathology laboratories, within this constantly changing NHS environment. The study initially reviews the political debate surrounding the 'commercialization of the NHS under the Conservative government of the 1980 - 90's. The history and development of MLSO's within the NHS at this time has been examined, embracing theft relationship with the medical pathologists, and this has been drawn into the study.

The case study centres on a group of MLSO's in a typical pathology laboratory in the north of England, and by utilising both participant-observation and key-informant evidence, has increased the understanding of how the moves to 'commercialize' the NTIS have affected the employment and professional issues faced by these MLSO's. In order to assess the extent of this 'commercialization', the study has also considered the similarities and differences between these NHS MLSO's, and those employed in a comparable private sector pathology laboratory.

Although the background to the NHS changes is complex and provides a constantly changing environment, it has been possible to show how the MLSO's in the study have been affected, and that this may be further extended to MLSO's in general. The main impact seen has been through the introduction of general managers into the NHS, who have brought about changes to the terms and conditions of MLSO's, particularly with regard to the introduction of altered working patterns (such as shiftwork), and also other wider aspects of MLSO work such as the increased use of both laboratory automation and the cheaper, less qualified staff grades (medical laboratory assistants).

The study has also found that although differences exist between MLSO's in the NHS and private sector, these are becoming less obvious, with an apparent convergence of the two types.

Other issues have emerged from the study, including the impact of the extended role of other health professionals (particularly nurses) and the continuing advances in science and technology, particularly robotics, which will play a major part in shaping the future role of MLSO's.