When the British National Health Service was founded in 1948, professional employees and support staff, with the exception of family doctors, worked directly for the state. Since the 1980s, private employment in the National Health Service (NHS) has steadily grown. Beginning with the outsourcing of support services, the number of privately employed workers in the National Health Service has gradually increased. This paper argues that marketization in the health sector has increased dramatically under the New Labour government. As policymakers have moved from ideological to pragmatic justifications for marketization, union opposition has similarly become more pragmatic and less ideological. With unions unable to stop these reforms, they have turned to the practical concerns of their members in partially-privatized workplaces under complex employment arrangements. This article shows that while ideologically opposing marketization, unions and employees have been forced into a more pragmatic position. Research at two privately-funded public hospitals shows that unions in the workplace have used their resources to protect their members, as thwarting the involvement of the private sector is nearly impossible.