The health sector has offered something of a roller-coaster ride for IT professionals over the past 10 years. Now the market is becoming more stable and offering a range of career options and professional roles.
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After Labour came to power in 1997, it did not raise spending levels for the first two years. This meant little changed in the historic problems with health service IT. Scarce resources were prioritised to provide clinical care and recruit and retain health professionals. Strategic investment in IT to help the NHS run more efficiently was difficult.
Although the government started to release more money to the NHS from 2000 onwards, IT spending was seldom ring-fenced and was often raided to help meet local priorities. As the private sector experienced an IT boom, NHS IT staff were left on modest salaries with the constant challenge of maintaining ageing systems.
In 2003, all that changed. The Department of Health announced the national programme for IT (NPfIT), an unprecedented increase in NHS IT spending, most of which was to be centrally managed and awarded to private sector suppliers.
In total, the government committed to £6.2bn worth of private sector NHS IT contracts, which included upgrading infrastructure, building care records applications, creating a national booking service and developing systems to transfer prescriptions electronically.
"The market when the NPfIT was first contracting attracted a lot of IT professionals to suppliers wanting to work in the NHS market," said Bryan Corke, head of public sector at recruitment firm Hudson. "Since many of the contracts were running for 10 years, IT people were looking to get in and get set up with good stories to tell so they could pick up other jobs during the lifetime of the contract."
Corke said these contracts offered attractive salaries for a range of IT jobs, including application development, infrastructure design and project management involving multiple suppliers.
Meanwhile, those working within the NHS were having a different experience. The Department of Health launched a massive pay restructuring programme within the service in an effort to increase the pay of those directly in contact with patients, particularly nurses.
During 2004, the preparation for this programme, dubbed Agenda for Change, caused many IT professionals to fear their roles were being grouped with clerical staff rather than as strategic support to the service. Some even feared their salaries would be cut.
In December 2004, Assist, an organisation which represents NHS IT managers, working with the Department of Health Agenda for Change steering group and other bodies, developed a series of generic job profiles that reflected how their area of health informatics was structured.
The group believed it had protected IT salaries in the service, with a recruitment and retention premium of 30% available in some areas. However, some insiders said the broad range of pay bands for the IT staff profiles left a great deal to local discretion.
"IT salaries within the NHS are still low," Corke said. "There have been some small increases, but you are not going to achieve the top-end rates. Our experience in NHS shared service providers, the primary care trusts which manage GP services and hospitals is that they have difficulties with budgets."
But although the pay may not be the most attractive in the market, Corke said, the NHS does offer certain IT professionals good opportunities to gain fast promotion to senior roles. Many NHS IT professionals left the NHS in favour of private sector service providers, leaving gaps in the service. Those moving sideways into the NHS may find promotion opportunities quickly.
"There is definitely a culture of recruiting from within, although not adverse to looking to people from the private sector. If you move in sideways and move up there is less competition," Corke said. "A lot of staff have been there a long time and new people can make a mark very quickly."
Another draw of working in the NHS is the satisfaction of delivering systems that benefit public services, Corke said. "Electronic patient records will allow doctors to share information no matter where they are in the service. That may be vital. For an IT person, making that happen is a good project to be involved with."
This is something NHS IT professionals agree with. Douglas Ball, director of IT at the NHS Prescription Price Authority, said he had achieved tremendous satisfaction from his achievements with the NHS. However, he said IT professionals entering the service should be prepared to develop subtle people skills to get the job done.
"IT is very successful where you have a meaningful relationship with colleagues in other disciplines. Being able to empathise with others and understand their concerns is essential. Technical skills are important but you need to understand people. This is important, because unlike in a commercial organisation, it is difficult to tell everybody to do their jobs in a certain way - there is no benevolent dictator. You need more subtle persuasion."
Although those working within private sector suppliers to the NHS may be able to reap the higher salaries in the short term, their choice may prove a mixed blessing, Corke said. "For a career, the jury is out. In high-profile projects there is always going to be pressure about failure.
"They can get a lot of publicity about not performing and that can be seen as a weakness. But you cannot stop Connecting for Health [the body that runs the NPfIT] and you cannot stop the reform."
The recruitment rate among private sector NHS IT suppliers has slowed since the first year of the NPfIT as the companies gained the skills they need or exhausted the market, Corke said.
Philip Virgo, strategic adviser at the Institute for the Management of Information Systems, predicted that the market for NHS IT jobs would even out as the initial massive investment spreads through the service. "In two or three years most of the teething trouble will be over and IT professionals will start to knit together the new generation of systems," he said.
Those IT professionals with the right mix of technical and people skills may be well placed to get a rewarding career.
Case study: working as an IT director in the NHS
Douglas Ball is director of IT at the NHS Prescription Pricing Authority (PPA), an organisation that processes about 600 million prescriptions a year and helps the NHS get value for money from drug companies, as well as helping GPs with their prescribing strategies.
Ball joined the PPA in 1978, after working in IT for the Electricity Board. "I started on a two-year contract to see if we could computerise the PPA. We had no IT department to speak of and we took over a group of 24 people. Now there are 250 in the IT department."
In 1982, Ball worked on the roll out of a national computer system for the PPA, which was completed in 1986. Since then there have been several upgrades to the system.
Although it has been a challenging journey, involving tight budgets and balancing the requirements of different professional groups, it has also been very rewarding. "We provide the basis for £8bn worth of prescribing in England. We allow researchers to access about four billion prescriptions in many different iterations. This would be impossible without the systems we put together. I get tremendous satisfaction from this job," said Ball.
"In our first year we saved about £80m from the prescribing budget and we have gone on to provide valuable information to the National Institute for Clinical Excellence."