Pay and reward in health care services: insights from the case of the UK

It is axiomatic that health care services are primarily framed by the relationship between the patient and the clinician (doctor, nurse or therapist, etc.). As such, it follows that the pay and reward of clinicians and other employees is a primary concern for all health systems. In this chapter, we examine pay and reward in this context of the UK health care system, in four sections. First, we examine the organisational and political saliency of pay and reward in the National Health Service (NHS), the dominant health care system in the UK. Second, we review some of the theories of reward determination, specifically in relation to health care. Third, we examine two contrasting studies that illustrate the extremes of pay and reward - the Living Wage and Clinical Excellence Awards (CEAs). In the final section, we assess these cases in the light of the contemporary context, namely, post-COVID recovery of services, financial constraints and worker shortages. Whilst pay will continue to be at the forefront of debate (not least for employees themselves), we conclude that there is a pressing need to consider the wider reward for staff. This is essential if health care is to deliver accessible, high-quality services.