The restructuring thesis and the study of public services

Environment and Planning A, 1989, volume 21, pages 905-926

The restructuring thesis and the study of public services

S P Pinch Department of Geography, The University, Southampton S09 5NH, England Received 13 April 1987; in revised form 27 May 1988

Abstract. The relevance of the restructuring thesis for the analysis of recent changes in the structure of public services is considered. It is argued that recent changes in public services are far more complex than suggested by the notion of privatisation and that a variety of concepts previously applied to the study of manufacturing industries can also be applied to the study of public services. The concepts considered include intensification, rationalisation, technical change, and self-provisioning. The paper concludes with a research agenda for analysis of public service restructuring.

Introduction One of the inevitable results of a fragmented interdisciplinary subject area such as geography and urban studies is that ideas can be widely accepted in one part of the discipline and yet be neglected in other parts of the subject. A good example of this was the institutionalist school which grew in the field of industrial economics (Kerr, 1954), led to the school of urban managerialism (Pahl, 1975), and yet was almost totally ignored by industrial geographers. A parallel situation exists today; what can be termed the restructuring thesis has come to dominate much of industrial geography (Massey, 1984), yet, until very recently, has been largely ignored in studies of public services and collective consumption. In this paper I argue that this state of affairs is undesirable and that useful insights can be gained by an integration of restructuring ideas and study of the public sector. In the first part I seek to examine what is meant by the concept of restructuring. This is followed by an examination of the relevance of the key concepts embodied within the notion of restructuring for an analysis of changes taking place in the public sector in contemporary Britain. Particular attention is paid to a study of the restructuring of hospital services in the Southampton and South West Hants Health District between 1980 and 1987. The study is part of a wider investigation into the restructuring of the Southampton city-region. The health authority covers most of the Southampton travel-to-work-area and with over 8000 employees is one of the largest employers in the region.

The restructuring thesis and the public sector Rather like privatisation, the concept of restructuring can be said to have obtained 'a high level of use and a low level of meaning' in recent years. Martin, for example, uses the term to "denote the broad process of economic, technical, social and political reorganisation of the socio-economy around a new structure of production, work and welfare" (1987, page 2)—a definition which does not exclude much from contemporary social change. Such definitions have the advantage of highlighting the interconnections between many of the complex changes taking place in capitalist economies, but lack rigour when attempts are made to understand the detailed links between production and consumption. It is certainly true that many have written of the restructuring of the welfare state in advanced economies. Gough, for example, used the term restructuring in his pioneering study to refer to

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changes in the nature of the welfare state to meet the needs of capitalism (1979, page 138). There are many other authors who have written of the aggregate changes in the structure of welfare systems in advanced economies to meet the need of profit accumulation. New words have been coined to describe these changes such as "recapitalisation" (Miller, 1978), "decollectivisation" (Harloe and Paris, 1984), "recommodification" (Harloe, 1981), and the growth of the "Warfare State" (Castells, 1985). However, use of the term restructuring in these aggregate theories differs substantially from the meaning the term has come to assume in studies of changing regional economies. In the context of manufacturing the concept of restructuring has come to involve a specific set of ideas which, in general, have been ignored by those writing on the public sector.

As Warde (1988) points out, the restructuring thesis was an attempt to align Marxist economic theory with increasing knowledge of spatial differentiation in the world economy. It is certainly possible to unhitch some of the ideas and let them roam free from their attendant baggage train of Marxist ideas, as has happened in a number of recent empirical studies of localities, but in so doing one loses sight of the interdependence between the many notions that underpin the restructuring thesis. There are many such ideas and the emphasis given to particular aspects by different authors has changed over the years, but some of the key concepts can be summarised as follows. 1. Instead of areas or regions becoming more alike—the homogenisation thesis (Warde, 1985a)—areas of the world are becoming increasingly differentiated along a number of dimensions. 2. This process of differentiation can best be understood in terms of the imperatives of capitalist accumulation. Spatial differentiation has become a resource used by capital in the search for profit. 3. The need for profitability has led to the emergence of a new international division of labour (Frobel et al, 1980). Warde (1988) argues that one of the main achievements of the restructuring school has been the detailed case studies of particular sectors in different areas. Yet, paradoxically, the 'new international division of labour' thesis suggests that we are witnessing the decline of regional sectoral specialisation. It is argued that, whereas in the past the economic health of regions was linked to their ability to specialise in all aspects of the production of particular commodities (such as textiles or shipbuilding), in recent times the economic health of regions is linked to their ability to specialise in particular stages of the production process of a wide range of commodities. 4. The evolution of this new international division of labour has been the result of many factors, two of the most important being: first, the growth of multinational and multiproduct companies operating at a global level; and, second, technological change permitting the separation and fragmentation of different stages of the production process into different regions. 5. Central to the emergence of these new spatial divisions of labour is the need for capitalist enterprises to control the labour process and to adapt to variations in labour supply, in terms of costs, skill levels, and militancy. Thus, it is argued that headquarters will concentrate in or near the major cities but research and development activities will concentrate close to headquarters areas in high-amenity environments favoured by professional workers. Those industries requiring particular skills amongst production workers will focus upon areas with pools of craft labour. In those instances where it is possible to introduce automation or where there is a desire to employ cheaper workers without a history of industrial militancy, then peripheral areas may be sought. Hence, the restructuring thesis has recently been linked with studies of localities which have drawn attention to the growing

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differentiation of production within different parts of the evolving space economy of Britain (Cooke, 1986). 6. There are a complex set of overlapping hierarchies of spatial divisions of labour in different areas. These hierarchies can best be understood by a historical perspective which examines various 'rounds of investment' over time. This process can be summed up by Massey's now classic phrase "the social and economic structure of any given area will be a complex combination of that areas succession of roles within the series of wider international divisions of labour" (Massey, 1978, page 116). This has led to the famous geological metaphor—rounds of investment are deposited like layers in different combinations in different areas. This metaphor has been much criticised (Warde, 1985b; Newby, 1986), although so far no alternative metaphor seems to have been suggested. 7. The regional restructuring of economies involves more than a geographical transfer of employment, and includes a complex class restructuring based on the changing social relations of production. Thus, complex hierarchies related to ownership and the technical division of labour will be reflected in the class structure of the areas (Massey, 1984). These changes in turn will have impacts on the domestic sphere, voting, and political mobilisations. These relations are again amongst some of the most controversial aspects of the approach. 8. Restructuring is the product of interactions between capital, labour, and the state.

Public services differ in two important respects from the private manufacturing concerns that lie at the heart of the ideas discussed above: first, they are responding to very different imperatives than those of profitability; and, second, they display fewer absolute variations in employment between different regions (Marquand, 1983). As Massey (1984) points out, these two factors are obviously related. There is an obligation on most public-sector agencies to provide roughly equal—or at least some adequate minimum—level of provision of services throughout their jurisdictions. If such services were subject to simple profit considerations, many areas would go unserved. Thus, most publicly controlled services do not display the same spatial hierarchies of inequality and specialisation as the private sector (Massey, 1984). Given the administrative structure and organisational goals of public-sector bodies, it is obvious that they cannot play off workers in different regions in the same manner that multinational manufacturing companies can.

Despite these differences, there are a number of grounds for considering the relationships between the restructuring thesis and the development of the public sector in more detail. First, there is a growing recognition that previous work on restructuring has been preoccupied with the manufacturing sector and there is an urgent need to look at the process of restructuring within the services sector (Sayer, 1985). Conceptualising and distinguishing services from manufacturing have proved extremely difficult and have drawn attention to many of the parallels between the two sectors (see Walker, 1985). Whether a service is provided by private markets or on a nonmarketed basis may ultimately prove to be a more important factor than the somewhat arbitrary services-goods dichotomy, but this should not at the outset rule out of court an extension of the restructuring thesis to the public sector.

Second, and following from the above, consideration of the services sector has drawn attention to the enormous variety of ways in which services can be provided. As Mark-Lawson et al (1985) point out, services can be provided: first, within households (usually by the labour of women); second, by private markets; third, through the informal neighbourhood economy, either directly for money or

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indirectly for barter; fourth, by voluntary and charitable organisations; and, fifth, by the state at either central or local level. In addition, there is the possibility of various hybrid forms of provision through arrangements whereby central or local government supports various forms of provision by the voluntary or private sectors (such as through tax incentives). Although the theory of public goods would suggest that there are certain goods and services with characteristics which make it impossible for provision through private markets, apart from a few extreme cases such as defence, there are few technical reasons why services should be provided by one particular form (Pinch, 1985).

This potential for substitution between forms of service provision is best revealed by those nonstatutory services which display wide variations between one part of a nation and another. Care for children below the age of five is provided in all five of the forms of provision noted above, and there are widespread variations in the mix of services in different parts of England, largely depending upon the degree of local state provision (Pinch, 1984). The potential for variation in the form of provision is also revealed by the considerable variations in the nature of provision between different countries. In addition, there is a growing awareness of the need to link processes in the workplace with those in the domestic sphere and in the sphere of state service provision. The work by the Lancaster Regionalism Group has done much to uncover this interdependence. Research has shown that variations in welfare provision in northern towns in the interwar period can be related to the nature of political mobilisation by women in the communities, which in turn can be related to the nature of the dominant workplaces in the communities concerned (Mark-Lawson et al, 1985; Savage, 1985). The main implication of the above discussion is that analysis of the public sector should not be compartmentalised but should be integrated with analysis of the rapidly evolving structure of private-sector service provision which, like the restructuring of manufacturing industry, shows signs of wide geographical differences in different parts of the country.

Following closely from the above discussion is a third main point. The application of restructuring ideas to the public sector is also suggested by recent efforts to 'privatise' public services and to apply cost-efficiency yardsticks to those services which remain within the public domain (Evans, 1985; Le Grand and Robinson, 1984). Spencer (1984) argues that many of the changes currently taking place are in fact best described as 'contracting out' since local authorities maintain considerable control over the specification and tendering process for many services, whereas 'privatisation' implies complete withdrawal of the public sector from a particular area. Whatever the name chosen to describe the process, there is little doubt that many of the recent changes in working practices and service delivery within the public sector parallel those to be found within the private sector. Early work in the private sector was very much concerned with restructuring as a response to the need to control the work force (Massey and Meegan, 1978), and it was argued that this was much less important in the context of services. Recent work on restructuring in manufacturing has widened our knowledge of the range of factors which induce restructuring and has again developed parallels with the study of services (Flynn and Taylor, 1986).

Another closely related issue which has highlighted the need for study of the public sector has been the much-discussed concept of 'flexibility' in production. This term has been used to describe a wide range of changes in production ranging from computer-aided design to flexible manufacturing systems and changes in working practices (Atkinson, 1985). It has been argued that these new flexible production strategies have the potential to undermine existing spatial divisions of labour, with the prospect of reagglomerations of industrial activity in traditional


industrial heartlands (Cooke and Morgan, 1985). The meaning of flexibility and the extent to which it has been introduced into manufacturing has become extremely controversial. There have been suggestions that the extent of changes has been exaggerated and that flexibility has become more of a managerial ideology than a specific set of developments in many firms (Pollert, 1987). One paradoxical feature of this flexibility debate is that there is little work on the issue in the area where many suspect that changes have been most intense in recent years—the public sector. Indeed, the model of the flexible firm portrayed by Atkinson (1985) bears a striking resemblance to a model of the public sector which many on the political Right would like to see become a reality. Under this model, a core of managers would be responsible for subcontracting out public services to a set of flexible firms at minimum cost to the public purse. There are many reasons why there has been a lack of explicit recognition of the issue of flexibility in the public context (see Pollert, 1987) and again this suggests an urgent need for analysis of the public sector.

One final point serving to emphasise the need for studies linking notions of restructuring with the public sector is the fact that in many localities the decline of manufacturing and the slow rate of service growth mean that the public sector has come to dominate the economy. Indeed, in some localities the public sector has been a major contributor to job loss through the contraction of utilities and transportation, and in many Labour-controlled authorities public services are now considered as a major potential source for future employment growth (Labour Research Department, 1985). In most areas the public sector, in various forms, is a key employer and a major influence upon local labour markets. One of the major justifications for studying localities is that they are the major scale at which external forces affect an economy through local labour markets (Pickvance et al, 1986). There is a very real danger that in studying the impact of private-sector imperatives upon changes in localities, studies will be preoccupied with the distinctive work culture of particular industries in the private sector, to the neglect of important work cultures in the public sector.

Analysis of the issues discussed above raises many thorny problems, but there are some signs of a consensus developing over certain desirable objectives in future research strategies. There is a growing recognition that what is needed are forms of analysis that take account of interrelationships between changes in the sphere of work, changes in the sphere of households, and changes in the sphere of state activity. Such work must also avoid the cardinal sins of, on the one hand, functionalism and reductionalism (in which household activity and state activity are seen as dependent upon the imperatives of the capitalist system in the sphere of production) and, on the other hand, the absolute autonomy approach [in which households and state structures are seen as evolving largely independently of one another (Humphries and Rubery, 1984)]. In addition, such work must take account of the role of human agency and the importance of localities in the evolution of social forms must be recognised. Even if this much is recognised, clearly there is still room for considerable argument. The rest of this paper is therefore speculative in form and, in the light of the requirements specified above, is an attempt to consider how the restructuring thesis might be applied and modified to the study of public services.

Restructuring and public services The study of evolving service provision in advanced capitalist economies is characterised by many abstract theories which are difficult to 'pin down' in an empirical sense, especially in the context of particular localities (see Miles, 1985).

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Daniels and Thrift (1985) point out that 'postindustrial', 'self-service economy', and 'circulation of capital' theories all suffer in various ways from reductionism, to the extent that service growth is envisaged as a response to economic growth within manufacturing sectors. They also note that, as a result of this tendency towards reductionism, these theories are somewhat insensitive to the complexities of developments within particular services (Daniels and Thrift, 1985). The work of Urry (1986) is particularly useful in this context, for he has attempted to adapt the restructuring thesis to service provision. However, apart from the health service, most of Urry's examples are taken from the private sector. In the following subsections therefore I take Urry's categories and evaluate their relevance to the public sector.

Partial self-provisioning Table 1 shows the parallels between forms of restructuring in the private and public sectors. The first category of restructuring is derived from the work of Gershuny and Miles (1983). These authors have drawn attention to the ways in which, as the cost of technology is reduced, certain services which were previously purchased outside the household can be replaced by the use of goods within the home. The classic examples are the substitution of videos and televisions for cinemas and 'live' sports, and microwave ovens for eating out in restaurants. The driving forces behind these changes are envisaged as essentially technological because these innovations affect the relative costs of goods and services. The work of Gershuny and Miles has been criticised on many grounds, not least because of its overtones of technological determinism and the way their analysis ignores the effect of various social and political struggles (Urry, 1987). Nevertheless, if social and political struggles are introduced into the equation, then the notion of self-provisioning can be introduced into the realm of public services. One can then conceptualise trends towards self-provisioning, not simply as the result of technological innovations, but as the result of efforts to move from collective towards individualised modes of consumption, reinforced by ideologies stressing 'individual responsibility' (Rose and Rose, 1982).

The extent to which communities and households are able to engage in self-provisioning has been the source of divergent trends in recent years. On the one hand, modern technology has produced many machines which ease the burden of

Table 1. Forms of service sector restructuring. (The categories of restructuring and most of the examples of private services are taken from Urry, 1987.)

Private sector Public sector

1 Partial self-provisioning Self-service in retailing Child care in the home Replacement of services with goods Care of elderly in the home Videos, microwave ovens, etc Personal forms of transport

Household crime-prevention strategies, neighbourhood watch, use of antitheft devices, vigilante patrols

2 Intensification: increases in labour productivity via managerial or organisational changes with little or no investment or major loss of capacity Pressure for increased turnover per The drive for efficiency in the health service

employee in retailing Competitive tendering over direct labour operations, housing maintenance, refuse collection

Increased numbers of graduates per academic in universities


Table 1 (continued).

Private sector Public sector

3 Investment and technical change: capital investment into new forms of production often with considerable job loss The development of the electronic office Computerisation of health and welfare

in private managerial and producer service records services Electronic diagnostic equipment in health

care Distance learning systems through tele

communications video and computers Larger refuse disposal vehicles, more

efficient compressed loaders

4 Rationalisation: closure of capacity with little or no new investment or new technology Closure of cinemas Closure of schools, hospitals, day-care

centres for under fives, etc Closure or reduction of public transport

systems

5 Subcontracting: of parts of the services sector to specialised companies, especially of producer services Growth of private managerial producer Privatisation or contracting out of cleaning,

services laundry, and catering within the health service

Contracting out of refuse disposal, housing maintenance, public transport by local government

6 Replacement of existing labour input by part-time, female or nonwhite labour Growth of part-time female labour in Domination of women in teaching

retailing profession? Increased use of part-time teachers

7 Enhancement of quality through increased labour input, better skills, increased training In some parts of private consumer services Retraining of British Rail personnel

Community policing?

8 Materialisation of the service function so that the service takes the form of a material product that can be bought, sold, and transported Entertainment via videos and televisions Pharmaceuticals rather than counselling

rather than 'live' cinema or sport and therapy?

9 Spatial relocation Movement of offices from London into Relocation from larger psychiatric hospitals

areas with cheaper rents into decentralised community-based hostels

Relocation of offices from London to realise site values and to reduce rents and labour costs

10 Domestication: the partial relocation of the provision of the functions within forms of household or family labour Closure of laundries Care of the very young and elderly in private

houses after reductions in voluntary and public service

11 Centralisation: the spatial centralisation of services in larger units and the closure or reduction of the number of smaller units Concentration of retailing into larger units Concentration of primary and secondary Closure of corner shops hospital care into larger units, that is, the

growth of large general hospitals and group general practices

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domesticity, but the decline of the extended family and the breakup of traditional community networks have undermined the ability of people to cope with the burdens of caring for dependent groups. Whereas the key process behind increased self-provisioning in the realm of the private sector has been the desire for profit, the major imperative in the case of nonmarketed services in Britain has been the desire of Mrs Thatcher's Administration to reduce the size of the public sector by expenditure cuts and 'privatisation'. The extent of these processes would seem to vary considerably between different localities in Britain, especially as many Labour-controlled councils have resisted central demands for expenditure cuts (Pinch, 1987). The effect of these changes upon forms of self-provisioning is a key area for future research.

One new trend which might be encapsulated within the heading of self-provisioning is the increased reliance of local authorities upon unpaid volunteers to make up for staff reductions. These include volunteers who assist the social services and parental helpers in schools (Webster, 1985). So-called rationalisation of facilities (see below) has also increased pressures for self-provisioning. The closure of residential accommodation for the elderly, the reduction in forms of preschool provision, and the reduction of the school meals service have all put additional pressures upon families—and therefore usually upon women—to look after dependent groups. Last, one of the most important developments leading to increased self-provisioning amongst households is the development of so-called 'community care'. Although reducing the extent to which recipients of care are incarcerated in large institutions through the provision of smaller decentralised facilities in the community is in many respects a laudable aim, in practice 'community care' has often come to mean the closing down of older institutions with inadequate community services, thereby pushing the burden of care back upon families and informal networks within neighbourhoods.

Intensification The second category in table 1 relates to intensification—increases in labour productivity via managerial and organisational changes with little or no investment or major loss of capacity. This concept is again highly relevant to the public sector where some of the most extreme examples of intensification can be found. In the British National Health Service (NHS), for example, efforts have been made to increase the rate of output for given levels of input. Thus, the number of patients treated per member of staff has been increasing. In the Wessex Region there has been a 9.3% increase in the number of patients treated, while the number of beds has fallen by 3%. This has been made possible by reductions in the length of time that patients spend in hospital and by a 25% increase in the number of day-care cases (Wessex Regional Health Authority, 1987). This higher throughput of patients has increased the workload upon the medical and nursing staff. In the case of nursing this has often involved a reduction in shift overlaps. Increased throughput is accompanied by a higher proportion of patients who are in the most dependent phase of their treatment, thereby increasing the demands they place upon staff. Increasing the numbers of dependent patients has put additional pressure upon junior doctors, making the long hours traditionally worked by this group even less desirable. In the Southampton and South West Hants Health District considerable efforts have been made to reduce the number of unsociable rotas, but, given that each junior post costs between £14000 to £19000 per annum, it has proved difficult to increase the number of posts within existing cash limits. Some nurses interviewed in Southampton claimed that it was the intensification of work rather than low pay which was primarily responsible for the low morale within the profession. As in


many other areas of Britain, it has been difficult to obtain certain specialist and senior nurses. It has been suggested that one consequence of this intensification is absenteeism. In Southampton, absenteeism, defined as absence from work for reasons other than sickness, is not especially high but the absence of nurses because of sickness is said by managers to be "causing concern". Intensification has also affected clerical and administrative workers in the NHS. The increase in work loads has been associated with a reduction in the total numbers of administrative staff.

Intensification has also been under way in higher education, as the number of graduates per member of academic staff has been increasing in recent years (Urry, 1987). Contracting out of services, or at least the use of the threat of contracting out, has enabled many local authorities to intensify some of their spheres of operation, most notably in the context of direct works. In Southend, contracting out of refuse disposal enabled the abolition of the 'task and finish5 system whereby workers completed the job after a 'task' rather than after a certain number of hours (Evans, 1985).

Intensification can also be brought about by a policy of redundancies, non-replacement of retiring staff, or a greater reliance upon part-time work. All of these strategies put increased pressures upon a diminished work force. The pressures can be especially acute in a field such as social services where there are additional demands upon the remaining staff because of increasing numbers of the elderly, unemployed, and 'at risk' groups. Increased numbers of elderly and unemployed have also increased the demands upon the library service. Reductions in casual labour and overtime and increased staff redundancies have intensified the work loads of staff and have reduced staff cover for sick leave and holiday leave. In Bradford staffing in the library service is to be restructured so that less qualified junior staff have to take on additional responsibilities (Webster, 1985).

Investment and technical change Investment and technical change refer to situations in which heavy capital investment in new forms of production results in job loss. In comparison with manufacturing sectors, little is known about these forms of change in the private service sector, but many changes are underway in the sphere of nonmarketed services. These include the computerisation of health and welfare service records, the introduction of electronic diagnostic equipment in health care, and the possible use of distance learning systems using videos and computers in education (Gershuny and Miles, 1983). So far, most of this technology has had little impact upon the overall structure of employment in the public sector. New skills in the sphere of computers and software have been required and few jobs have been shed as a result (Gershuny and Miles, 1983). Many service jobs in the public sector, such as nursing and social work, involve caring for people and are therefore difficult to replace with technology. It was recently reported that in order to cope with shortages of nursing staff for intensive care, Guy's Hospital in London had started to use a computer-controlled system for altering drips. Because the patients are unconscious it is argued that 'the personal touch' of a nurse is unnecessary, although some might argue that, since experience of sound is the last faculty we lose, the human voice is important even when unconscious!

In the Southampton and South West Hants Health District the increasing emphasis upon new technology in medical care has led to demands for skilled operators and technicians. The NHS pays considerably less than the external labour market for such skills and there has been frequent 'poaching' of trained staff by the electronics industry which is an important element of the local economy. One response has been the progressive upgrading of jobs undertaken by workers after the introduction

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of new machines. This has the effect of raising salaries and helps the health authority to retain staff.

New technology has also been used in Southampton to reduce labour costs. This has primarily affected administrative workers through the introduction of computerised outpatient bookings systems, patient records, wages and salaries, and management information systems. This process will continue in the future and may extend to pathology where automation is seen to offer considerable potential for labour reduction. Part of this process of cost cutting has also involved the introduction of cook-chill catering systems. In most of these cases the NHS may be seen to be catching up with the private sector which has been much more ready in the past to introduce new technology to improve efficiency and reduce labour costs.

There seems to be general agreement that the jobs most vulnerable to technological change within the service sector are clerical jobs where word-processing systems can lead to staff reductions. Bradford Council is reported to have halved the number of typists employed, by the introduction of a centralised word-processing system (Webster, 1985). There are also fears about the impact of new technology in lessening job satisfaction through reduced promotion prospects and declining autonomy over working practices. It is interesting to note in this context that the introduction of new technology increased the problem of controlling the work force concerned with refuse disposal in Southend. Larger more efficient refuse disposal vehicles meant that workers could complete the tasks in a few hours and additional work had to be provided as overtime. The net result was that the workers had, by manual standards, relatively high incomes at additional cost to the authority (Evans, 1985).

Rationalisation Rationalisation refers to the closure of capacity, with little or no new investment. The most commonly cited examples of rationalisation in the context of private services are the closure of cinemas and laundries. There are, however, many more examples of rationalisation in the context of public services such as the recent closure of schools, hospitals, and welfare centres. Although many of the criteria involved are apparently rational and technical, as in the case of contracting out, closures are inherently political in character. Evidence from the USA indicates that, even when the criteria for school closure are based on technical issues applied in an explicit manner, the most detrimental effects are often upon the poorest communities (Honey and Sorenson, 1984).

There would seem to be wide variations in the extent to which it has been possible to cut back and 'rationalise' public services. Thus, there have been considerable reductions in nonstatutory services such as preschool child-care facilities and services for the elderly in some areas, but, as Mohan (1988b) notes, cutting back the NHS on any radical scale is not possible without damaging electoral consequences for the Conservative Government. Similarly, there are growing public pressures directed against the reduction of resources devoted towards education. Le Grand (1984) argues that the crucial factor affecting the vulnerability of a service for rationalisation would seem to be the class composition both of service consumers and of producers. When, as in the case of education and the National Health Service, there are both powerful middle-class producer groups and middle-class beneficiaries, the scope for rationalisation is limited. In the case of social work the beneficiaries are the poorer sections of society, but the providers are middle class, so these occupy an intermediate position in terms of their vulnerability to rationalisation. Those services such as refuse collection with working-class producers are easier to hive off to private contractors (see the next section).


In addition to class there is, however, another powerful explanatory factor which can be related to local government cuts—namely gender. Webster (1985) notes that not only are the services most vulnerable to cuts dominated by women providers but they are also the services in which the consumers who have most to gain are women. Women dominate many of the manual local government jobs that have been cut or contracted out and are left to shoulder the main responsibility as carers after the withdrawal of services, by acting as family carers.

In general, it would seem that there are a number of poorer, marginalised, and often discriminated-against groups that can suffer from public-sector policies of fiscal retrenchment. Thus, after the fiscal crisis in New York in the mid-1970s many of the blacks who had been recruited into the public sector through equal opportunity programmes in the 1960s were laid off (Sheftner, 1980).

Subcontracting Category 5 in table 1, subcontracting, is again a useful concept for analysing the public sector. Many of the private-sector producer services that have been growing so rapidly in recent years are, of course, a response to the privatisation (or more appropriately contracting out) of certain facilities such as cleaning and catering within the NHS. In Britain, subcontracting has usually led to a decreased work force, an intensification of the work process (category 2), inferior wage benefits (for example, reductions in sick pay and holidays), and the absence of trade unions (Spencer, 1984). It would appear that the main effect of the introduction of private contractors into the health service has not so much been a reduction in hourly wage rates as a reduction in the total number of hours worked, thus taking workers below the sixteen-hour legislation needed to qualify for employment-protection legislation (Mohan, 1988b).

The extent of privatisation has varied enormously between different local government areas, largely depending upon the political persuasion of the council (Moon and Parnell, 1986). In the Southend case the contracting out of refuse disposal was made possible by a combination of pressure from ratepayers and a right-wing council determined to gain increased control over the work force, albeit through the use of an external agency (Evans, 1985). In Dudley, the privatisation of the school meals service led to a reduction in the number of staff employed and a 40% cut in hours. Kent, Hertfordshire, Somerset, and Wirral have changed the conditions of service for part-time school meals staff by making them redundant and reemploying them to work shorter hours without the benefits of free lunches, holiday pay, and retainer payments during school holidays (Webster, 1985).

In the Southampton and South West Hants Health District the majority of catering, laundry, and domestic services put out to competitive tender have been awarded to the authority's own internal staff. Unions were hostile to the process of competitive tendering and adopted a policy of noncooperation. The process therefore involved local managers contacting workers directly to draw up detailed specifications for jobs which reduced costs to below those which could be offered by outside contractors. In Southampton General Hospital the number of hours worked by the cleaning staff have been cut by 25% with no reduction in the amount of work undertaken. The total number of cleaning staff was reduced from 337 to 252 and 43 workers on part-time contracts lost their jobs. The new job specifications have reduced restrictive practices and there is now more flexible deployment of staff. Part-time night staff who used to clean the casualty department have been dispensed with and emergency cover is now provided by cleaners who deal with operating theatres. Union officials argue that these new practices have led to a decline in staff morale and lower standards.

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Paul (1984) claims that Medway District Health Authority deliberately declined to put ancillary services out to tender at hospitals where it was felt that union resistance would be particularly strong. In the case of Southampton General Hospital the ancillary services which have so far been affected by competitive tendering have all been dominated by female workers who might be expected to be less resistant to change than some of the male-dominated services that have had a history of 'difficult' industrial relations in the past. However, considerable changes have been made to working practices in these male-dominated ancillary services and it is intended to put security, portering, and driving out to competitive tender in the future.

The growth of part-time work Urry's sixth category, the replacement of existing full-time labour by part-time work or by marginalised workers, is a trend whose full significance in the context of public services has yet to be assessed. The rights of part-time workers are usually limited in relation to full-time workers, depending upon the number of hours that they work. In comparison with those working between sixteen and thirty hours per week, those working for less than sixteen hours per week lose rights of protection from unfair dismissal, entitlement to redundancy pay, and maternity provisions (Webster, 1985). Those working less than eight hours per week have almost no rights at all. It has been argued that the policy of reducing working hours to below sixteen hours has been most developed in the public sector (Labour Research Department, 1984). A number of local authorities have reduced the hours worked by part-time school meals staff to evade employment-protection requirements. There is also growing evidence that local authorities are making increased use of part-time teachers to overcome supply problems in particular areas. This would seem to arise because job losses in teaching have been concentrated in full-time jobs, whereas the number of part-time teachers has remained constant. Teachers who return to part-time work are generally restricted to the lowest grades on the Burnham scale and generally have fewer opportunities for training and promotion (Webster, 1985). The shift towards part-time employment seems to have been most pronounced in the libraries and museums service.

The significance of these developments is open to question, however, for different local authorities have responded in different ways to the same financial pressures (Travers, 1983). Some local authorities have concentrated staff reductions in the sphere of part-time work. These are predominantly, although not exclusively, the nonmetropolitan authorities such as East Sussex, and Hereford and Worcester. In marked contrast, other authorities—predominantly in metropolitan areas—have increased the number of part-time workers while reducing the number of full-time workers. Karan (1984) has argued that, in general, there is a shift towards part-time work because this gives local authorities greater flexibility to deal with financial uncertainty. There is also a pronounced shift towards the use of part-time workers within the NHS, although it is not altogether clear at present to what extent this reflects a response to financial stringency or to recruitment problems (Mohan, 1988a).

In the Southampton case the NHS makes far less use of part-time staff than the private sector does. In particular, private hospitals make extensive use of part-time nurses, whereas part-time nurses are almost entirely absent from the NHS. Although there are administrative problems in dealing with a large number of part-time workers in large units, the NHS seems likely to make much greater use of part-time workers in the future to deal with problems of staff shortages. An area in which there has been increasing use of part-time staff is administration.


The NHS (together with other parts of the public sector such as the university and local government) pays below the going rate in the private sector for secretarial staff (a contrast of up to £2500 per annum at the top of the scale). The public sector thus has to make greater use of school-leavers and part-timers. In this instance the use of part-time staff is largely forced upon the health authority rather than being a chosen labour strategy. In some areas of ancillary services, contracting out has involved increased use of part-time staff. Interestingly, it has been found that increased use of part-time staff in this way can lead to less flexibility in terms of labour deployment. Whereas in the past, low-paid full-time workers had been prepared to work overtime to supplement their wages, it has proved more difficult to persuade many part-time workers to adopt more flexible working rotas. It is assumed that this rigidity arises because of domestic constraints upon such workers. It is interesting to note in this context that part-time cleaners taken on by private hospitals are expected to be on call when needed at almost any time and there is no shortage of women prepared to undertake such work in the Southampton region.

The enhancement of quality and the materialisation of service functions Question marks also hang over the significance in the context of the public sector of categories 7 and 8, the enhancement of the quality of services and the materialisation of service functions. Certainly, efforts have been made in certain spheres of the public sector to increase the quality of services through retraining schemes. Some of these schemes have included instruction of personnel in issues related to race and gender and their implications for local authority service delivery. Efforts have also been made to make local authorities more responsive to the needs of communities through neighbourhood participation schemes and the establishment of decentralised neighbourhood offices. Much of the initiative for these schemes has come from councils that have been dubbed T h e New Urban left' (Gyford, 1983) and these changes stand in stark contrast to the general push towards cost reduction. The effect of privatisation and subcontracting upon the quality and efficiency of public services is of course an enormously controversial issue at the present time. Two recent reports indicate that privatisation of telecommunications (British Telecom Unions Committee, 1986) and water services (Patterson, 1987) has led to a deterioration on the quality of services for private consumers compared with industrial interests.

Spatial relocation, centralisation, and domestication In his recent paper Urry (1987) has extended his early typology (Urry, 1986) with three more processes at work in the context of services. Two of these, spatial relocation and centralisation, are closely related processes which are long established in the context of public services. Examples are shown in table 1. Domestication is another concept which is closely related to the partial self-provisioning described above. Clearly, many of these processes shown in table 1 are closely linked and will be taking place simultaneously in any particular service.

Limitations of the restructuring thesis and possibilities for further analysis in the context of public services Urry's typology is clearly an amalgam of the early ideas of Massey together with the approach of Gershuny and Miles (1983). Just as Massey's initial threefold classification of intensification, investment and technical change, and rationalisation has been modified and extended (see Flynn and Taylor, 1986), so there is clearly considerable scope for modification of Urry's typology in the context of services. It is immediately apparent, for example, that there is considerable overlap between many of the categories. Thus, domestication might involve self-provisioning together

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with materialisation, and intensification is usually related to subcontracting. It is also possible for many of these processes to work in reverse; restructuring could lead to a decrease in self-provisioning in certain areas or to the dematerialisation of services (for example, more counselling and therapy rather than drugs; increased tailoring of computer programs rather than simply the provision of hardware). What does seem clear, however, is whether by accident or some overall grand design, most of these processes are leading to a decline in union power and the reassertion of managerial initiative.

One important criticism directed against the 'layers of investment' analogy in the context of the restructuring thesis is that this metaphor will be used to provide historical descriptions of the evolution of divisions of labour without an adequate understanding of the processes responsible for these changes (Newby, 1986). What has become apparent from studies of the manufacturing sector is that there are an enormously wide range of restructuring strategies available, the nature of wliich depends upon factors such as the corporate structure of the business, the changing nature of the product market, the nature of the technology employed, the character of the production process, and the nature of the labour process. Even when one 'controls' for all these factors, similar firms have a wide capacity to respond to these imperatives in different ways. A similar degree of complexity will undoubtedly exist in the public sector. For example, different areas of local government have responded in different ways to central pressures for expenditure cuts. There are, nevertheless, grounds for thinking that theory building will be easier in the public sector than in the study of private companies.

First, despite the importance of recent changes, all things being equal, one would expect there to be less dramatic changes in, say, local government services than in private companies. One must be careful not to exaggerate this point, however, for there are indications that many private firms have not restructured to the widespread extent that much of the more speculative writing would lead one to believe (Pollert, 1987). Indeed, many firms have hardly changed in any significant way at all in the last ten years and it is debatable whether many of those changes that have taken place are extensive enough to qualify for the label of 'restructuring'. Second, one would expect there to be greater similarities between types of local authorities than in the case of private companies. There is considerable exchange of ideas between local governments through professional journals and the personal contacts of members of political parties. Thus, innovations in the sphere of economic development have spread rapidly amongst Labour councils with a strong 'copycat' element. Third, there is likely to be greater uniformity of pressures upon local authorities. The external pressures from central government upon local governments are likely to be more similar than the enormous diversity of external pressures upon private companies. The effect of these pressures upon local governments will, of course, present many complex outcomes because of the enormous complexity of the different environments in which they operate. Indeed, in at least one respect the public sector is more complex than many private businesses, for local governments contain an extraordinarily diverse work force. There are professional groups such as doctors; many 'semiprofessionaP groups such as planners, teachers, and nurses; and many relatively low-paid groups such as cleaners.

As in the case of private companies, therefore, the restructuring of local governments can be envisaged as a response to 'top-down' and 'bottom-up' pressures mediated by internal characteristics of the organisations. Table 2 is an attempt to list some of these pressures.


What is less clear from such a typology is how such factors will affect spatial variations in restructuring. There are some fairly obvious political correlates which are reflected in the attitudes of Conservative-controlled and Labour-controlled councils to issues such as contracting out and cuts in services (Moon and Parnell, 1986; Pinch, 1987). The influence of factors such as local labour markets and professional factors is less clear.

Table 2. A typology of pressures for restructuring upon local authorities and other public-sector bodies.

External pressure from 'above' Cuts in Rate Support Grant Central controls over standards of provision Pressures for 'privatisation' Changing technology Legislative changes and legal judgments Internal pressures from 'below' Changing demographic structure leading to changes in demand for services Changing client pressures for increased quality of services, for example, education Growth of antibureaucratic and decentralist tendencies, tax revolts Mediating factors Entrenched professional interests Attitudes of local trade unions Political aspirations

Restructuring of health services in Southampton Some of the interrelationships between these types of factors can be appreciated from analysis of the restructuring of primary health care services in Southampton in the 1980s. Although Southampton contains its own unique combination of industries, in general terms the city shares a number of characteristics in common with other urban areas in southern England. These characteristics are a relatively high proportion of so-called 'high-tech' jobs, a comparatively low rate of job loss in manufacturing industries (with very few closures of large or medium-sized establishments), a relatively low rate of unemployment, a comparatively high rate of new job formation, a high rate of employment growth in services, and sustained demand for private housing, leading both to high rates of housebuilding and to booming house prices. However, this prosperity is not evenly distributed throughout the region and there are pockets of poverty and deprivation both in the inner-city areas and on some peripheral local authority estates (Robinson and Pinch, 1987). The Southampton and South West Hants Health District encompasses inner-city areas with their growing proportions of the elderly and outer-city areas with their rapidly growing population of younger age groups.

These characteristics of the Southampton economy reflect the changing spatial division of labour within Great Britain. A number of different trends have been observed from studies of the main sectors of the local economy . Some companies have been consolidating production in the region, transferring work from other regions into the area. Other organisations have progressively upgraded the sophistication of the products which they make in the area, shipping lower level work to the Far East or to peripheral areas in Great Britain. Overall, the Southampton city-region has experienced a consolidation as part of the 'core' of the UK spatial economy, with greater emphasis upon research, development, marketing, and control functions; a progressive upgrading of the skills of the work force; a growing emphasis upon financial services; and a shift from a pyramid-shaped to a diamond-shaped employment structure (Pinch et al, 1988).

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These developments provide the general background to changes in the health service in the area. Changes in the structure of the service can be conceptualised in broad terms in a similar manner to changes in other sources of employment. Wider forces of change, in this case pressures for cost reductions and greater efficiency emanating from the Department of Health and Social Security (DHSS) and filtered through the Wessex Region, interact with the particular features of the Southampton district and are mediated by factors such as local labour-market conditions local administrative structures, and the behaviour of local trade unions and professional groups.

Many of the pressures on the Southampton district are similar to those in other districts and therefore require little comment here. It should be noted, of course, that in recent years the district has experienced problems of funding and fiscal retrenchment on a variety of fronts. Although the Wessex Region as a whole is RAWP positive(1), in recognition of the rapidly growing population in the area, it is generally accepted that the reallocation of money has not kept up with the rate of inflation in the cost of medical care. In common with other regions, Wessex has granted its staff pay increases that cannot be met within existing cash limits. Wessex currently has less consultants that it should have and this has meant decreased career opportunities and heavier workloads for junior doctors. This was confirmed in a recent DHSS report; Wessex was the only region in which the number of junior doctors working rotas of worse than one night in three had actually increased in recent years [Southern Evening Echo, 9 April 1987). Within the Wessex Regional Health Authority 173 out of 800 junior doctors were being asked to work more than one night in three. Within the Southampton Health District cuts have also come about as a result of Southampton University's funding of the Medical School. University staff look after about one third of all patients admitted to Southampton General Hospital for acute surgery. One consequence of these reductions has been increased waiting times for patients awaiting nonurgent surgery. Indeed, Southampton's hospital waiting lists rank amongst the worst in the country. In March 1987 there were 8217 people awaiting treatment of whom 1427 were classified as urgent. Of this second group 933 or 63% had to wait more than a month for treatment. Of the 6790 cases classified as nonurgent, 29% had to wait for more than a year. Despite a higher throughput of patients, there has been a 50% increase in the waiting list for in-patient treatment between 1978 and 1984 in Southampton.

Although the Wessex Region does not face the problems of unemployment and deprivation which characterise northern areas such as Middlesbrough (Townsend, 1987), population growth and buoyant labour-market conditions create their own pressures and issues. It has been estimated that the increasing population will lead to a 20% increase in demand for health services in the Wessex Regional Health Authority in the next decade (Wessex Regional Health Authority, 1987). It is also estimated that two of the groups which make the most demands upon health services, children and those over 65, will increase by 57000 and 36 500, respectively, in the region in the next decade. Indeed, the administrative district of Southampton experienced one of the largest percentage increases in the numbers of persons above the age of 65 of all urban districts between 1971 and 1981 (13.72%). As a result of these increases in demand it is argued that an increase in staff of 15% will be needed. However, within existing cash limits only an increase of 10% can

W The Resource Allocation Working Party (RAWP) scheme sought to allocate resources between regions in relation to relative need.


be envisaged. In addition, if pay awards continue at their present levels, then it is envisaged that the increase of staff can only be 4%, with a subsequent decline in standards.

A key impact of local economic conditions upon health services is through problems of recruitment of certain types of staff. For example, in 1987, shortages of theatre nurses led to the closure of one of the operating theatres in the Royal South Hants Hospital. Buoyant labour markets mean that there are numerous other types of job opportunities for nurses and labour turnover is high. This is, of course, a national problem, the root cause of which is widely suggested to be the low level of nurses pay. Recruitment and retention of qualified nursing staff have become increasingly problematic, particularly in the acute and specialist medical areas. The pay issue in Southampton is exacerbated by the high cost of local housing and the relatively high level of average local wages outside the NHS. In contrast, Townsend (1987) notes that recruitment of nurses was not a major problem in Middlesbrough, where lower living costs and high unemployment discourage moves away from the public sector. It has been estimated that one in five nurses in the Wessex region 'moonlight' in some capacity. This is less than the one in three nurses who are said to take on second jobs in London but much less than the 4% who are said to moonlight in the north. The existence of two private hospitals in the Southampton region, together with numerous private rest homes for the elderly and growing demands for nursing care within the home, serves to create opportunities both for permanent jobs and also additional money through short-term agency nursing. (The problems of recruiting staff are not restricted to hospitals. Some of the building societies interviewed claimed that there was a higher turnover of staff in Southampton compared with northern areas. They claimed that 'poaching' was a problem, for once they had been trained, staff were attracted away by other companies.)

Another way in which local factors affect health policy is through the operations of local bureaucracies. Many central policy statements give only broad guidance and it is left to the discretion of local regions, districts, and hospital units to evolve their own codes of practice depending upon the issues in hand. The Griffiths Report (Social Services Committee, 1984) attempted to affect the relationship between doctors and general management through the introduction of clinical budgets. However, the report laid down only general principles and it has been left to each district and region to evolve its own interpretation of general management. This is well demonstrated in the Southampton and South West Hants Health District where there are considerable variations in the management structures introduced in the different hospitals.

For example, the large Southampton General Hospital (about 5000 staff) has a structure which is based upon the North American 'Johns Hopkins' model. This is somewhat unusual in Britain, let alone Wessex. This pattern is based upon the assumption that, since medical costs are expensive, the only persons who can effectively control them are doctors. The structure was initially introduced to Britain some years ago at Guy's Hospital in London, where, in a fashion somewhat similar to recent conflicts in the NHS, cardiac surgeons continued to operate on children irrespective of financial constraints. The structure at the Southampton General Hospital attempts to control costs through the creation of clinical service units such as Medical, Theatre, Pathology, and Surgery, each managed by a clinical services manager (a doctor) and an assistant clinical services manager (sometimes, although not always, a nurse). This structure puts the emphasis upon reducing costs and increasing efficiency. This structure is very different from that to be found within the Royal South Hants Hospital (about 1300 staff), the other major

922 S P Pinch

hospital in Southampton, where there is still a Director of Nursing Services, and only one unit medical representative instead of thirteen clinical service managers.

A major component of the Southampton study has been an attempt to evaluate the extent to which dualism or segmentation is occurring in local labour markets. By this I mean the tendency for workers to become partitioned into nonoverlapping segments of labour markets in which there are growing differences in factors such as working conditions, pay, and promotion prospects. The introduction of Griffiths principles of general management has had some bearing upon these issues in the health service. In the pre-Griffiths period, lines of accountability for nurses were purely professional and upwards in a long and complex hierarchical structure which created the prospect of considerable career mobility for many nurses. Until recently the NHS was managed by a tripartite system of doctors, administrators, and nurses. This system enabled the propagation of professional values in which patients' or clients' needs were defined in terms of the knowledge and objectives of the particular professionals involved. This system, which survived the reforms of 1974, was acceptable in a period of expansion but made it difficult to implement general management principles in a period of fiscal restraint. The Griffiths reforms were an attempt to redress the balance in favour of general management principles.

Under the Griffiths management model, managerial responsibility for all staff in a unit is vested in a unit general manager. There is growing evidence that the nursing profession (or semiprofession) has lost out to the medical profession as a result of these changes. These changes have had two important effects. First, it has created a complex system of dual accountability in which nurses are responsible to other senior nurses for professional issues and are responsible to general management for other issues—a difficult if not impossible distinction to maintain. Second, it has truncated the elaborate hierarchical career structure of nursing and has meant that, if nurses want to progress, they must get into general management. Many older nurses, in particular, who could have looked forward to promotion within the old system have found their career opportunities blocked.

As part of the Griffiths reorganisation twenty senior nurse officer jobs were eliminated at the Southampton General Hospital and were replaced by thirteen general managers many of whom were not nurses. It has been argued that consultants played an important part in the process for, as clinical service managers, many declared themselves hostile to the introduction of nursing officers as assistant managers. In practice, many nurses were appointed as clinical service managers but there was undoubtedly a loss of morale amongst nurses in many quarters. These reduced employment opportunities only affected a minority of nurses and for the majority, as for many other workers in the health service, there is no elaborate career hierarchy.

To draw the above information together, it can be argued that there are less likely to be distinctive locality influences at work in the context of public-service restructuring compared with privately owned services or manufacturing. Many of the changes observed in manufacturing in Southampton, for example, are similar to those in other southern sunbelt locations (Pinch et al, 1988). In the case of hospitals, however, Southampton displays problems similar to other large provincial cities throughout the country, including those in northern areas, albeit intensified by the growth status of Southampton leading to high living costs and labour shortages. Factors such as internal administrative reorganisations bear no relationship to these labour-market characteristics. There is, however, a relationship within the areas between the character of the hospital and the form of administrative change. The largest hospital, The General, which has experienced the most difficult industrial and organisational problems, was subject to the most intensive form of change.


Avenues for further research The basic thrust of this paper is that recent changes in public-sector service provision are too complex to be encapsulated by any simple term such as privatisation or subcontracting and that further insights into recent changes can be obtained by the application of restructuring notions to the public sector. In this section, I consider some of the key questions which emerge from such an approach.

1. To what extent have recent changes led to a deskilling and polarisation of the public-sector work force? There is now a growing amount of literature relating to manufacturing and to a lesser extent to private services about the impact of recent employment changes upon the composition of the work force. It is also important to examine the extent to which the public sector is reinforcing or ameliorating the effects of private-sector changes.

2. What effect has recent restructuring had upon the composition of the work force in terms of skill, gender, age, and race? Again there is a growing body of literature relating to private manufacturing and services. It is becoming well established that many employers are especially reluctant to take on young people. In some sectors women have suffered as a result of redundancies and nonreplacement of jobs and in other sectors they have gained from the growth of part-time employment. It is clearly of considerable interest to know to what extent the public sector is able to ameliorate these tendencies and to what extent it reinforces them.

3. What has been the effect of these changes upon service provision in terms of criteria of equity, quality, and efficiency? These issues are enormously complex for each of these criteria can be measured in many different ways. Efficiency can be regarded as the ratio of resource inputs to a given level of output by an organisation (Spencer, 1984). Calculations of efficiency will therefore concentrate upon the internal costs of the organisation compared with contracting out costs. The quality and equity of service provision, on the other hand, relate to the outputs of the service and their impact upon the local community.

4. What has been the effect of restructuring in the public sector upon self-employment? In recent years there has been a considerable increase in the number of self-employed persons, many of them women in the service sector in education, health catering, and cleaning (Daniels and Thrift, 1985). The significance of this trend awaits investigation.

5. To what extent are there geographical variations in the extent of public-sector restructuring in different parts of the country? An important related issue here is the extent to which the political complexion of the council, the nature of the service, and the character of local industrial relations, affects the type of restructuring that is to be found? Early work has uncovered a pronounced spatial concentration of contracting out in Conservative-controlled local authorities in the South East, South West, and East Anglia, but the pattern is changing rapidly (Moon and Parnell, 1986). Work on the NHS has also begun to unearth pronounced regional variations in employment change (Mohan, 1988a).

6. To what extent do public-sector services and industries have an effect upon, and to what extent are they affected by, local work cultures in different localities? Are working relationships consensual, antagonistic, or paternalistic? To what extent are these relationships the result of occupational, sectoral, or locality effects?

7. How important are variations within the public sector? Most of the examples discussed above have been taken from local government and the health service. There are, however, many other aspects of the public sector, together with recently privatised services, which require research: post and telecommunications, transport services, utilities, public research institutions, and miscellaneous bodies such as the Ordnance Survey.

924 S P Pinch

Conclusions In this paper I have highlighted the ways in which the extensive battery of concepts that have emerged from the study of industrial restructuring can be used to analyse contemporary changes in the structure of welfare systems. The major advantage in linking concepts from industrial restructuring to the analysis of changes in the public sector is that they reveal how diverse are the changes in the nature of the welfare state in recent years. The application of such concepts is long overdue for, ironically, some of the most extensive changes taking place in working practices in Britain are to be found in the public sector. In Southampton, for example, the most extreme cases of intensification have emerged through the intensification of ancillary work in the NHS. In contrast, much of the private sector has revealed relatively little change. It could be argued that in terms of productivity the public sector is attempting to catch up with the private sector. However, the wages paid within the public sector are generally below those for comparable jobs elsewhere. Furthermore, in many private-sector companies in Southampton, increased flexibility has been bought in return for higher wages—a development which has not been replicated in much of the NHS.

The major limitation of ideas from industrial restructuring in the context of public services is that they focus upon outcomes rather than on pressures for change. Although many of the outcomes in the public sector parallel those in the private sector, the pressures upon public-sector organisations are very different. Furthermore, the range of the types of change taking place in the public sector would seem to be less than in the private sector. Because of the political and fiscal constraints upon local authorities they have less capacity for closing 'plant', shifting product lines, making redundancies, or investing in new equipment. There is an additional problem stemming from the sheer diversity of concepts that are currently available leading to the possibility of an incoherent eclecticism. The important task for the future therefore is to link these notions with some of the broader aggregate theories discussed at the beginning of this paper.

Acknowledgement. This paper arises from research supported by the Economic and Social Research Council (Project D00232180).

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The restructuring thesis and the study of public services

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