From the very late 1990’s up until the time I retired, I worked in an office. I chose a different career path that involved sitting in front of a computer doing things with other computers and servers for the British Healthcare system: the NHS.
Some background
Across the 23 years I spent in the NHS, many changes were made to the administrative structure of the service. It’s a public service, which means the current Government calls the shots. Should the Government change (as it has a few times over 23 years), then the structure of the service can change based on the new Government’s directions.
For the most part though – and very broadly speaking – this is invisible to the end-user (the patient), as the actual treatment service stays basically the same. The dentist still treats teeth, the hospitals still administer treatments etc. The changes are sometimes big, sometimes samll.
In my case – and applying to the IT service I was working for – we had several merges and changes.
- I started in the NHS providing IT support for 100 (admin) users in a Health Authority (as it was called at the time) in one building with an autonomous network. Very little internet, very little email. Almost no outside networking (to other NHS Authorities) at all.
- About a year later, there was a big Governmental change, where Health Authorities were scrapped and Trusts were created out of the ruins. Trusts were several previously autonomous organisations networked and merged together from an administration point of view. The two main hospitals in the county where I live merged together to form one Acute Trust and basically what was left over (Community Hospitals, GP Surgeries, Dentistry) became the other Trust. I worked for the other Trust, providing IT support for all the little Community Hospitals across the county.
- A few years later, more Trusts were created. More networks were created, joining more NHS sites together. You could now electronically send files, emails or any other electronically accessed information to other NHS Trusts anywhere in the country. Initially three Trusts (excluding the Hospitals Trust) were created, subsequently expanding to five. My IT department still provided IT support for everyone except the Hospitals Trust.
- The final change (and it must have been the current Conservative Government that did it!) was yet another shake-up of the five Trusts down to one, with my IT department merging with the Hospitals Trust. So off I went to work for the Hospitals Trust, supporting thousands of NHS users based all over the county. Happy days.
NHS Money
Let’s talk about the funding. Where the money comes from and how it’s spent.
Very simplistically speaking, Trusts get allocated money from the Government (via the taxpayer), they spend it on providing services, wages, equipment etc. The money is allocated up by a finance department to different internal departments of the Trust. IT gets a budget, Radiology gets a budget, A&E gets a budget and so on and so forth. The exception to this is when there’s a project (usually a big one) in the offing (a new building, new equipment, new systems, refurbishmsnts etc.) the Trust can apply to the Government for additional funding outside of the usual allocated budget. That’s granted (or not) on a case-by-case basis.
Sometimes, the Government will issue a directive to implement something NHS-wide across the country. In that case, the directive is issued and the various Chief Executives for the Trusts will negotiate funding to deliver it.
Or not, in the case of Fujitsu (remember them), who were engaged to provide an electronic patient records system and didn't (that was in 2008 and the court case is still ongoing, I believe).
Two very different funding systems
In terms of IT there were two very different funding scenarios:
The “other” Trusts”
The non-hospital Trusts (the “other” Trusts like Community Hospitals, treatment centres, admin centres), the IT department held the responsibility of provisioning all of the IT systems. Everything from desktop PC’s to printers, to servers, to network switches and firewalls. Not just the email servers and file servers that everyone used, there were domain services (which enabled you to have an account and logon to systems) and networking systems (which enabled you to use different systems, like network printers, faxes (yes there are still faxes in the NHS!) and of course, the internet.
The budget was suitably sized so that we could replace user equipment (PC’s phones, mobile phones, printers, cables etc.) on a rolling basis, we could provide “IT consumables” (paper, backup tapes, printer ink, even batteries at one point) and we had enough money for any system upgrades that we’d thought we’d need in the upcoming year. Licensing (Office, Windows, software like Adobe etc.) was also handled by the IT department and part of the IT budget.
User desktop PC’s were replaced on a rolling basis. If there was to be a new operating system deployed, licenses would be obtained and the PC’s were either upgraded, or if found suitably underpowered, replaced.
It was the same with servers and server operating systems. At the time I worked for The “other” Trusts, virtual servers weren’t affordable. So we ran our systems on individual servers. One server would provide email, one file services, one would be a backup server.
Any new ones, or upgrades would come out of the IT budget and be purchased accordingly.
The Hospitals Trust
After eight years of working for the “other Trusts” IT, we all got merged into the Hospitals Trust IT. And this IT department had a very different approach to IT budgets. As in the budget was hardly any!
In the Hospitals Trust, the IT budget was very small. It was very small, because all of the IT equipment and consumables used by the NHS staff was funded by the department they worked in. In radiology for example, all of the PC’s phones, printers and systems they used were paid for out of the radiology budget. If they wanted new PC’s they would pay for them and we (IT) would build them for them. Fortuantely, in most cases any replacement equipment they wanted to by had an IT department input (but that wasn’t always the case!), so we managed to maintain some modicum of standardisation.
Needless to say, unless we absolutely insisted upon it (and it used to be quite a fight), departments were reluctant to spend money on new equipment when they had perfectly good PC’s that worked. I recall a lot of questions being asked when we wanted to upgrade PC’s from Windows XP to Windows 10 for example.
Our IT budget was spent on providing core or shared IT services, like email and file storage, and we charged the user for the priviledge. That money was supposed to be re-invested in upgrading, renewing, replacing, licensing the core services as and when it was necessary.
In reality, that happened rarely. Yes, the requesting department was billed, but the money was usually spent on something else, like contractors to backfill for staff we didn’t have. But what it did mean – the IT department had little control over the systems software that clinical departments ordered and used.
If we wanted to implement bigger systems, such as a virtual platform that would cost in the order of tens of thousands of pounds, we would be obliged to write a paper outlining the system benefits to the Trust etc. and submit that to the Trust Board for approval. The Trust Board (usually made up from non-IT individuals) would then lead us on a song and dance about whether it was actually needed, whether it would cost that much and would it really provide the benefits listed in the white paper (it was called a white paper for some reason. I never used any colour other than white. Ever!).
You would never get the amount you asked for. It was always less, so we had to write and rewrite papers many times to either compensate (i.e. over quote) or write it in such a way that it would appeal to the non-IT person. We had varying success with this. We were granted money or we weren’t!
If we were granted the money (and the virtual platform system was a good example), it would be required to work for at least ten years. And as anyone on the IT industry will know, 10 years is a very, very long time.
Consequently, we had an awful lot of old servers that were still in use. Given that the average lifespan of a physical server is supposed to be five years (it’s more like two, now), we had servers that were running systems for twenty years or more.
We had a sticker on the server room door that read "Museum of IT Architecture"
One of the benefits of the Virtual Server systems was that you could migrate the servers from the old hardware onto them and get rid of the hardware liability of old equipment (we did write that into the paper), thus saving X amount of pounds on buying hardware support. In theory that was good, but in reality, you weren’t gaining all that much, as you still had the old server, just on a virtual system. The server was still running old unpatched software and was just as vulnerable from a security standpoint than it ever was.
Speaking with IT
Generally, when it came to getting the IT department’s input into projects (e.g. before buying new IT systems) to begin with, users generally didn’t.
That was kind of OK in the “other” Trusts as a) there weren’t many IT systems (they used the main hospital ones) and b) the budget was run by IT, so things like replacment PC’s the IT department would do regardless.
The Hospitals Trust however was a different kettle of fish. because The IT department didn’t hold the budget, the user generally thought they could buy what they wanted and just plug it in and it would work. When we were migrated to the Hospitals Trust to begin with, we were also fighting a culture issue. It transpired that hospital departments had been asking the IT department for input into their projects, however the IT department were so “unresponsive” that they never bothered again! They were so anti-everything that they would just say no to everything. Until we came along and pointed out that we were supposed to be supplying a service!
Over time, the communication between user and IT became much improved and things did get a bit better.
Summary
- Trusts and Organisations changed with Government directives.
- Two different methods of funding, depending on for whom wou worked.
- Money was always tight – especially for big IT projects – big money meant big justifications.
- The end user was usually unaware that they needed any IT input. “It’ll work if we plug it in, won’t it?”
What we’ve covered so far…
(Post 1) How an IT Department is Financed in the NHS