Almost 20 years ago, the Trades Union Congress (TUC) responded to falling trade union membership by introducing the organising model' through its New Unionism strategy (Heery 1998). The atrophy of the British trade union movement has continued regardless, with fewer absolute numbers and an even greater reduction in density, from 32% in 1995 to 26% by 2011 (Brownlie 2012). Trade union density in the public sector is higher, standing at 56.5% in 2011 compared to 14.1% in the private sector. As a result, over 62% of union members are in the public sector (Ibid. 2012). The immediate fortunes of the movement appear therefore to rest on this sector's resilience. As Richard Hurd has argued, in the United States, however, it would be a mistake 'to conclude that public sector unions are strong, stable, and immune to the external and internal influences that have brought private sector unions to their knees' (cited in Burns 2014: 53-54). Relatively high density should not be allowed to hide falling membership: from 4.11 million in 2009 to 3.88 million in 2011, with a loss of 186,000 members in 2010-2011. Nor should density figures mask the significant decline in collective bargaining. According to the authors of the latest Workplace Employment Relations Study (WERS 2011),
Collective bargaining takes place in less than three fifths (57%) of public sector workplaces, setting pay for a little over two fifths (44%) of public sector employees, down from over two thirds in 2004. (Van Wanrooy et al. 2013: 22)
The Institute of Fiscal Studies (2014) reported that 'The public sector workforce stood at 5.7 million in mid-2013, and made up just under 20% of total employment, lower than at any point in at least the last 40years' (p. 1). On-going cuts in public expenditure pose a further acute threat to public sector unions and hence the overall fortunes of British trade unionism.
As well as expenditure cuts causing job losses, there has been a general erosion of public sector wages, especially in the years since the economic crisis of 2008 and the onset of austerity, adding demoralisation to rising insecurity. The New Economics Foundation (NEF) found that the public sector had been hard-hit by 'the sequence of a 2-year pay freeze (three years in local government) and then a 3-year pay cap', the effect of which was 'to reduce median and average gross pay in the public sector by a prospective 13% across the period' (NEF 2013: 8). It is estimated that: 'one million public service workers are on low pay, including health and social care workers, school staff and local authority employees' (NEF 2013: 6). UNISON's own research found that 'When the national minimum wage was introduced in 1999, the bottom NJC [National Joint Council] pay point was over 24% above it. Now it's just 2% above' (http://www. birminghamunison.co.uk/news-archive/njc-pay-14-bulletin-44). Alongside the erosion of wages, pension changes have seen higher employee contributions, lower benefits, longer working lives and a reduction in the rate of inflation proofing. Hurd's warning of vulnerability is even more apposite given the 2015 election of a Conservative government, openly hostile to public sector unions, that has advanced plans for restrictions on industrial action and facility time as well as proposals for even greater expenditure cuts.
If public sector trade unions have performed poorly defending pay and pensions, areas in which they feel most comfortable and confident, their record with less tangible issues, such as control and respect at work, is equally unimpressive. Yet, it is conditions and relations at work that frequently come to the foreground when talking to public sector workers. Teachers' main employment concerns are workload and the growth of targets and intrusive monitoring (Carter & Stevenson 2012; Ironside et al. 1997). Healthcare workers worry about understaffing, arbitrary rotas, sickness monitoring and the extent of bullying (Francis 2013). Civil servants complain about the management of change, understaffing, targets and performance monitoring (Carter et al. 2011; Foster & Scott 1998). Without necessarily explicitly connecting the effect of these practices, workers in all sectors are concerned about the impact of them on their ability to deliver a quality public service to which they have a high level of commitment. As Burns (2014) notes of US workers 'Caring intensely about their work, public workers often gravitate [d] towards issues that motivated their membership, and dovetailed with the public good' (p. 69). Public sector workers in Britain are no different (Gill-McLure 2013; John & Johnson 2008). Nevertheless, focused and systematic trade union opposition to manifestations of management's control of the workplace and the related degradation of services is muted in the United Kingdom and workers' complaints largely unorganised.
The reasons for unions' workplace ineffectiveness are numerous. Relatively high density and coverage obscure evidence that unions in many public sector workplaces have been effectively 'hollowed out'. The fortunes of UNISON, the largest public sector union with 1,254,000 members, are crucial for public sector unionism as a whole. Since its formation in 1993, it has lost 250,000 members despite a number of strategies to raise the figure back to 1.5million (Waddington & Kerr 2015). One of the objectives was to use branch development and organising plans to require the implementation of policies directed towards increasing the number of lay representatives (UNISON 1998) and to bring about a ratio of 1 lay representative for every 50 members. However, the proportion of members with a lay representative present at their workplace fell from 72.3% in 1999 to 70.2% in 2000, dropping steeply to 52.3% in 2009 (Waddington & Kerr 2015: 9).
UNISON is a particular example of hollowing out, but an important one. The process within and across public sector unions is of course uneven (Simms et al. 2013). Unions operate in different conditions (concentrations of employment, occupational identities and disruptive capacities) and their national and local leaderships and strategies differ markedly: The Newcastle UNISON branch will differ from a county council branch in southern England and the firefighters' union is not UNISON. Nevertheless, in the core areas of healthcare and local government, there are some general features at work. Loss of members and long-term threats to their financial stability has led to mergers and accompanying rationalisations of union structures, centralisation and standardisation (Heery 1996) A frequent consequence is the erosion of occupational identity as a source of mobilisation (Gill-McLure & Seifert 2008). To be an engineer or a patternmaker was a source of pride and self-esteem that formed the basis of demands for respect and craft control of work processes through to the 1980s. UNISON, despite coming into the world with a large nursing membership, has failed to build upon occupational consciousness and now struggles to recruit nursing students. The Royal College of Nursing (RCN) brings apparent prestige and is focused solely on nurses. Where nurses are present in UNISON, they are more likely to be represented by non-nurses 'with the consequence that many health professionals may view UNISON as a union for grades other than their own' (Waddington & Kerr 2015).
Using evidence from trades unions given to The Mid Staffordshire National Health Service (NHS) Foundation Trust Public Inquiry (2013; hereafter Francis Report) as its primary source, this article discusses union failure to integrate professional issues of patient care and trade union practices and the consequences for membership engagement. The first section examines literature on public sector unionism to establish a general trend towards the hollowing out of public sector unionism. The second section establishes that these experiences are paralleled in the NHS and thus underpin a later argument that in many ways the practice of unions at Mid Staffs Hospital are more typical than many accounts would acknowledge. This argument is reinforced in the methodology section before a detailed analysis of the activities of the two main unions, the Royal College of Nursing (RCN) and UNISON, is undertaken. Finally, the need to build unions by focusing workplace organisation on everyday issues is emphasised. These issues necessitate the development of a patient-centred hospital workers' union (McAlevey 2014) that champions high standards of care and staffing levels and good workplace conditions that enable it.
The hollowing out of public sector unionism
The Donovan Commission (1968) on employment relations centred on the private sector, particularly the engineering industry, reflecting political concern with unofficial strikes in heavily unionised manufacturing industries (Fox & Flanders 1969). Governmental concern has now largely migrated to the public sector. Although the number of strikes are shared almost equally between public and private sectors, in 2010 over 80% of all days lost were in the former, a reflection of larger numbers ol participants (Office for National Statistics 2012). Higher trade union density and an increased propensity to strike also account for academic interest in public sector unions as the basis for a revitalised union movement. Darlington (2010), for instance, contends that there is 'important, albeit often neglected, evidence of continuing resilience and even combativity in certain areas of employment, notably within the public sector' (p. 129).
Fairbrother (1994, 1996, 2000) has been consistent in maintaining that the decentralisation of management decision-making has stimulated a process of union renewal with the latter viewed as comprising democratic, participatory and locally based forms of organisation. Fairbrother et al. (2012) reiterated that the changing organisation of state sectors provides a dynamic...