Staff retention for health informatics is poor.Now the NHS faces losing a key section of its workforce to private companies that could loan them back at higher rates.Steve Mathieson finds out what the NHS can do to secure employees

A health informatics person's lot is not, apparently, a happy one. It is certainly not well paid. The Department of Health's human resources strategy for this group, Making Information Count, says that for the most senior jobs, pay is 30-50 per cent below equivalent posts in the private sector - and 20 per cent below that available in other parts of the public sector. 'Even within the public sector, we do not pay favourably, ' says the strategy's lead author Diane Benjamin, programme manager for national health informatics development at the NHS Information Authority.

Her report quoted a 2000 survey which found that 43 per cent of health informatics staff leave for the private sector each year (health informatics includes IT, records and knowledge management staff - see box 1, overleaf ). But pay came just third on a list of reasons why people left. Lack of training and development and a stressful work environment were more important.

The NHS is going to need good IT staff as the massive national IT programme gets under way.

And in theory, now should be a good time to find them. IT and telecoms companies are struggling and surveys in the specialist IT press suggest that more people with IT skills are willing to consider working for the public sector than would have thought about it a couple of years ago.

However, Ms Benjamin says that, as these figures suggest, the problem is not recruitment, but retention. 'Whereas the downturn [in the IT job market] favours us at the bottom end where people want a job, I am afraid we do not keep them, ' she says.

Peter Dyke, head of market development at BT Health, is worried that this has left the NHS short of skilled senior staff. 'You are talking about people who have worked on strained budgets, fighting for resources, ' he says. 'People who can manage these complex portfolios do not exist.'

NHSIA is trying to make health informatics staff feel more wanted. It is, for example, helping to develop their own professional body.

The candidate is UKChip - the UK Council for Health Informatics Professions - which will maintain a register. Its website (www. ukchip. org) has already taken 600 registrations.

'Though it will be voluntary, ultimately it will be working towards statutory registration, ' says Di Millen, head of informatics development and academic relations at NHSIA.

'We have to persuade employers that they need registered professionals.'Making Information Count recommends statutory registration by 2007.

UKChip will be an umbrella body - an addition to existing organisations such as the British Computer Society and the Association of Information and Communication Technology Professionals.

'Realistically, I think this will take a couple of years to have an impact, ' says Ms Millen.

A new award is also being created for excellence in health informatics, to counter media reports of IT disasters and to improve staff morale. There will be a different theme each year. This year, significantly, the theme is 'people' and there will be five£5,000 awards for innovative approaches to the recruitment, retention, management, development and motivation of NHS health informatics staff.

Beyond this, there will be a new focus on how staff progress through the health service. 'What we do not have is a clear career pathway, ' says Ms Millen.

To tackle this, health informatics staff will get a personal development plan. Guidance on this should be ready by September and development plans should be agreed with managers by December.

A leadership programme for health informatics will be designed by April, though the first part of its implementation will take to the end of 2005.

Training and development is also being addressed.

Seventy-three per cent of health informatics staff have unmet training needs, according to the 2000 recruitment survey.

'Training budgets in IT departments are often minuscule, ' says Ms Millen. 'Some people who manage these functions say what's the point if people just leave? But people who provide training find there are benefits in recruitment and retention.

It is about ensuring that people do not want to leave.'

The NHS University will be the vehicle for NHS IT training, though it is designed to act as broker for existing courses. It will only commission or run its own if something is not already available.

When NHSU launches this autumn there will be a faculty of health informatics, both for those working in the area and for staff who need to use IT.

The latter will concentrate on the well-recognised European Computer Driving Licence, which has become the basic IT skills standard for the NHS. For specialists, the initial offering will be a fairly simple web-based learning assessment tool.

Ms Millen says this will provide 'gap analysis' - in other words, it will show where staff have holes in their knowledge, for their current role, or for a future one, and then point them to places where they can plug those gaps.

However, one IT director at a large trust, who says he is in favour of the professionalisation plans in principle, thinks this approach to training is focused too much on health-specific skills.

'In IT, what the NHS is short of is generically skilled IT people, ' he says, adding that this is also true of IT management. 'Barclays do not use ex-bank managers to run their IT, Sainsbury's do not use ex-store managers, but the NHS uses NHS staff.'

He feels that training the health service's IT staff mainly in health-specific skills could actually damage retention, since staff could feel they are becoming locked in to one career path.

One specific threat to staff retention - though it may be a great opportunity for staff individually - is the advent of prime service providers. These are the large firms the government will commission to handle the national IT programme.

Mr Dyke says some have had little to do with health for a decade.As a result, they lack experienced staff. 'There is a worrying trend, with some consultants trying to recruit people from the NHS and then loan them back at higher value, 'he says.

The latest guidance indicates there will be three varieties of PSP - local service providers, national infrastructure providers and national application providers (see news, page 21).

'The potential local service providers are headhunting staff from the NHS, ' says Tony Eardley, chair of Assist. 'We welcome the additional revenue, we welcome working with private companies - that will increase capacity. But the knowledge of NHS staff needs to be retained for the NHS.'

'It is a concern for us, ' says Ms Benjamin. 'You often find [NHS] project staffmove to the private sector at much-inflated salaries and we lose them, which is a shame.We are both fishing in the same pot.'

She says that negotiations with the potential PSPs cover this subject. 'We do not want to be scrapping over staff ', she says, adding that the priority must be to increase the quantity and quality of staff available to health service IT overall.

'Secondments and shared posts will be seen as best practice, ' she adds. 'To our mind, it doesn't matter if they work within a PSP or within a health authority.'

Overall, Mr Eardley says the HR strategy has merit, but worries its contents will not be implemented fast enough. 'Since the conference that launched the strategy, there seems to have been a void of action plans, ' he says.

'There is some confusion over the role of NHSIA, NHSU and the other bodies that are springing up.'

And, he adds, decent pay remains an important part of attempts to keep staff within the health service.

But general pay increases are not likely to be forthcoming, says Ms Benjamin. 'I would like to think a major change is that they will feel they are recognised in health. It should mean equitable pay structures, nationally maintained.We do not say they will get more money. But for many, it will mean potentially higher pay, because their qualifications are more likely to be recognised. l Box 1: who works in health informatics?

There are more than 20,000 health informatics staff in the NHS, more than three times as many as in 1993.

Information and communications staff, and health informatics senior managers and service directors are two of the six groups defined as working within health informatics.

The others are health records staff, knowledge management staff (eg librarians), information management staff (eg health data analysts) and clinical informatics staff (who support doctors and senior managers).

Box 2: main recommendations of Making Information Count Training and Development:

All health informatics staff should have a personal development plan from December.

Courses are being commissioned to meet known training needs.Career development guidance should be available from September.

All staff should have gained, or be working towards, a recognised professional qualification by 2005.

A 'fast track'health informatics development programme is being developed with key IT suppliers and should be available this summer.

A national health informatics leadership programme should be developed, with the first cohort completing in 2005.

Other recommendations:

lHealth informatics staff should have a decent working environment and move closer to patient delivery areas.

A new excellence award should be set up to recognise people who have 'made a difference'and raise morale.

There should be more professional recognition for health informatics staff.A register of professional competence should be established, with statutory regulation in place by 2007.

Making Information Count: a human resources strategy for health informatics professionals.

www. doh. gov. uk/ipu/whatnew/makeinfocount. pdf Details of the award scheme: www. nhsia. nhs. uk/nhid/accoladescheme