Engaging staff in the NHS: Aligning incentives to achieve higher levels of performance (Completed 2009)

As one of the biggest employers in the world, the NHS depends critically on its staff to deliver high standards of care. Despite frequent structural reorganisations, the relationship between staff and the NHS remains fundamentally the same today as at its inception in 1948. With the important exception of GPs and other independent contractors, almost all staff are salaried employees working under the terms of contracts negotiated nationally. The relationship between staff and the NHS reflects the nationalised industry model that prevailed after the second world war.

This model has served the NHS tolerably well throughout its history, but appears increasingly anachronistic in the context of current health reforms. With ministers aspiring to develop a ‘self improving’ NHS in which innovations in care are driven by patient choices and provider competition, the time is right for a radical rethink. Specifically, a central issue in the NHS Next Stage Review is how to secure more effective clinical and staff engagement in the next stage of NHS reform. This project is designed to address this issue by examining employee owned companies and the lessons they hold for the NHS.


To explore the relevance and applicability of the employee ownership and staff partnership models to the NHS, the Nuffield Trust is supporting HSMC in carrying out a project which is:

  • Summarising the literature on employee ownership and staff partnership models in other sectors.
  • Identifying and describing examples of partnership models outside the NHS eg in the independent sector and in other countries.
  • Organising a number of high level seminars to discuss the literature review and to understand current examples of successful employee ownership, like the John Lewis Partnership.
  • Preparing a report bringing together the results of this work and indicating how the NHS might adapt the learning from employee ownership and staff partnership models.
  • While an important focus of the project is be shared ownership, other aspects are also being examined, including the participative mechanisms used to ensure a productive dialogue between staff and managers, and the means used to give staff a collective voice in the organisation.


Ellins, J and Ham, C (2009) NHS Mutual: Engaging staff and aligning incentives to achieve higher levels of performance. The Nuffield Trust.

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Date: 2008-2009
Researchers: Jo Ellins and Chris Ham
Funder/partner: The Nuffield Trust.