The Download: NHS tech’s pay problem

There are no shortage of external reviews into why digitising the NHS is taking such a long time.

Both the public accounts committee and National Audit Office have investigated the (lack of) progress in the last couple of years, resulting in lots of reflections and recommendations.

The latest body to jump on the bandwagon is the Commons health and social care committee, which published its report on Digital Transformation in the NHS this summer.

The thrust of its findings had been revealed back in February when its evaluation panel slapped a damning “inadequate” rating on government progress to digitally transforming the NHS. This prompted a rebuttal from a disappointed government, which said it did not “recognise” the rating as reflective of progress.

Since then, the committee has busied itself with taking evidence from the great and the good of the NHS’s tech leadership, and invited the thoughts of other interested parties.

The result is a 46-page report which makes just nine recommendations, which feels realistically compact given the stretched and shrinking capacity of national tech leadership right now.

Change Agenda for Change restriction

The most eye-catching, important and probably controversial recommendation comes in relation to the tech workforce.

Tech chiefs have frequently highlighted the challenges the NHS faces in recruiting skilled staff when competing with the private sector, which has far greater flexibility and resource to offer attractive wages and packages.

This was reiterated to the committee by former interim NHS Digital chief executive Simon Bolton, who described the technology market as “incredibly difficult” amid “huge inflation in wages, particularly in the private sector”.

With pay in the NHS for the vast majority of jobs limited by the Agenda for Change framework and nationally agreed pay deals, the health service is left trying to attract tech experts with one hand tied behind its back.

The committee’s proposed solution is to simply not apply Agenda for Change to “Data, Digital and Technology” (DDaT) specialists. This would allow the NHS to offer bonuses or “capability-based allowances”, and other incentives, to attract the best candidates, and therefore “sustainably meet demand for DDaT specialists”.

Being bound by public sector pay scales is not unique to the NHS, with similar issues faced across the civil service.

But government departments are able to submit a business case to the Cabinet Office for approval to implement a DDaT pay framework, which allows them to offer more generous packages to high-skilled staff that are desperately needed.

The idea is these business cases can be funded by an associated drop in expensive temporary staff and/or contractors.

The committee argues this option should be utilised by the NHS, citing the health service’s reliance on third-party suppliers as a clear reason for why such a move would be justified. Certainly there are no shortage of examples of tech temps being paid significant sums in the NHS, even within NHS Digital itself.

But, it’s hard to see such a move going down well with other parts of the NHS workforce, who have their own frustrations over recruitment and pay.

And it’s nigh-on impossible to imagine the government waving through such a proposal at a time when medical staff are routinely striking over their own pay.

Nonetheless, it is likely that changes of this magnitude are needed to bring about real transformational change in the digital healthcare space.

Keeping the tech workforce on a same pay system as the rest of the NHS is clearly limiting the health service’s ability to digitally transform at a time when technology is developing at rapid pace and the subject of much investment from other organisations.

Train the wider workforce

The committee’s report cited Health Education England research which estimated that the 46,000 or so tech and IT staff in the NHS will grow to 78,000 by 2030.

It’s hard to imagine that many of these new recruits will be the brightest and best if the NHS is unable to compete financially with other sectors.

DDaT aside, the committee also rightly emphasised the importance of investing in the wider NHS workforce’s digital skills.

It recommended the Department of Health and Social Care work with NHS England to ensure digital training is “integrated throughout its wider learning programmes”, which sounds sensible, if vague. The recently published NHS long-term workforce plan also commits to doing more in this space, but again details are scarce.

The government is expected to respond to the committee’s report in autumn. It faces a choice of continuing with the unsatisfactory status quo or being bold in its vision for the NHS tech workforce, but the former seems more likely than the latter for now.