In this interview with a NHS fellow worker we talk primarily about two questions: firstly, the dismantling of NHS England (NHSE) and  the impact of around 18,000 job cuts on its various departments; secondly, about NHS data analysis work, its purposes and contradictions. 

As part of a group of NHS Data workers they have recently published this open letter against the outsourcing of NHS data infrastructure, the Federated Data Platform.

The government explains the dismantling of NHSE as an act against ‘red tape’, against the duplication of management work and a step towards decentralisation. As you can read in the interview, we should be wary of this explanation. A recent union study showed that the main victims of the 1,300 compulsory redundancies are not highly paid managers, but women and ethnic-minority workers on lower and middle pay bands. Because the ‘civil service nationality rules’ makes it difficult for non-EU workers at NHS England to be transferred to and employed by the Department for Health and Social Care, up to 480 people might lose their job, without redundancy pay and at risk of being deported. 

Apart from a direct attack on jobs of our fellow workers, the scrapping of NHS England has to be seen in context of a wider restructuring of the NHS with problematic aspects. On the 14th of May, the UK government published a new Health Bill. The bill transfers a long list of powers from NHS England to the secretary of state – including on workforce planning, digital and data systems, oversight and regulation of local NHS bodies, and more. It also hands the secretary of state broad powers to direct local NHS planning decisions.

The requirement for NHS foundation trusts to have councils of governors – a policy that provided the basis for a rather phoney ‘community involvement’ in the running of local hospitals – will be removed. And Healthwatch – a largely ineffectual, but formally independent organisation that gathered patient and public views – will be abolished. The bill includes powers to establish a single patient record – bringing together existing information on people’s health and social care use into one place within the government / civil service structure. Recent studies suggest the public trusts the NHS more than the government with health data.

In a future article we will look more closely at the current organisational changes, at the tussle between politicians, high-up civil servants and managers over power, and what it tells us about the irrationality of a hierarchical bureaucratic structure.

If you are affected by the restructuring, get in touch!

———————————————————–

I’ve worked at NHS England for five years. I work in the national part of it in data analytics. I work in a team that mainly looks at diabetes related data in national diabetes programs. This is the second restructuring process I’ve been part of despite only being there for five years. I’d say the structure of our team probably hasn’t changed too much despite going through a restructure and our jobs were not at risk, unlike the jobs of many others. 

The restructuring of NHS England

The last restructuring was bringing together NHS England, NHS Digital and Higher Education England. Those three organisations merged into NHS England. I think this merger process took about two years, which is two years of underlying stress for the affected people of not knowing exactly what’s going to happen.

The current restructuring started pretty crazy. Internally we were told that there would be a 20% reduction of staff. Then it became 50% of staff and then they said that NHS England was being scrapped altogether. All this over the course of about two weeks, which panicked everyone. All this was framed as getting rid of duplications and unnecessary management, which can be quite hard to hear because there are so many roles that are not managers. I think the confusion can come in because the banding doesn’t quite match bands in trusts.My role is at band seven. If I was working in a hospital, I doubt that there were any roles where I could be a band seven and not be line managing anyone. 

Then besides that, even the roles that are managers, they can be managing something that’s very integral to the NHS. For example, my team works with a program team that has several managers in it, and they are managing national programs such as the diabetes prevention program. Thousands and thousands of people go through the diabetes prevention program, and it’s very successful. That’s not a thing that we would want to disappear overnight.

And in terms of duplication of structures, I haven’t had that much evidence of that being true. Our team will be merging with the Department of Health and Social Care. There aren’t two diabetes prevention programs, for example. So there’s no one at DHSC managing that program. And this is not a big team, there are only five or so people in the program team that deal with making decisions about the program and two that do the data analysis. It’s part of a larger directorate. There are thousands of workers within data and analytics, who might be working on a particular program like the one I mentioned.

We don’t know how the merger will affect the teams and how they will work in future, but I was talking to a worker earlier who works for the South East region, and they know that their team is going to be reduced. I also know that a similar role in the civil service, at least for our analyst roles, is paid a bit less. This might not affect us straight away, at first we’ll at least be on the same conditions. Then there are workers who might not qualify to work at the Department of Health and Social Care because of the nationality requirements, because of their migration status. I can’t remember the exact roles, but you pretty much have to be a UK citizen. And some workers at NHS England are on skilled workers visas and their are stressed because they’re not certain of how the timeline of the transfer is going to work and if they need a certificate of sponsorship for leave to remain. How long is the NHS committing to providing it if they’re made redundant?

We’ve had one round of voluntary redundancies already. Management is trying to get down the headcount through voluntary redundancy across the board. At the last restructure there were job roles that couldn’t apply for voluntary redundancy, but now anyone can apply. We don’t know whether there might be a second round. 

It is difficult to understand why they want us to move over into civil service. Is it about a shift in the power structure and who has control over the work and budget? Is it some kind of centralisation of hierarchy? Or is it just about saving money? But why would they choose to save money on diabetes prevention? That’s a weird way to save money because you just end up spending lots of money on patients with diabetes. Then there are certain things the NHS currently carries out that are not allowed to be carried out by the civil service for jurisdictive or data governance reasons. I suspect that they will create something like NHS Digital again, which would be ironic.

The restructuring might make the cooperation between us data analysts and the program teams more difficult. As data analysts we collaborate in the process of deciding how the data should be collected. The data set that is created is called the minimum data set and this is revised and re-modelled during the process. The program team is aware that there’ll be things that they might not realise would or wouldn’t be useful, but that a data specialist would realise. And the other way around, I might not realise that there are certain things that would be useful to the program team. So it does have to be collaborative, and it does mean that we as analysts influence what is collected. And then there’s also an advisory group that includes expert clinicians, for example a GP who has expertise on diabetes.

The social labour of data analysis

For a socialist society, it would be of enormous importance that there’s a very dynamic process between new insights that are gathered on the level of local day-to-day experience, for example in direct contact with patients or within a new manufacturing process, and a transparent centralised analysis and debate about these insights on a wider social level. So in this sense there might be a lot to learn from the data collection and digestion process within the NHS.

We can see how important collaboration and close communication is when we look at the problems with outsourced data collectors, so called providers. There are often several providers on one program, e.g. a survey on diabetes services. For a national program across the country, there’ll be five, six different providers and there’ll be different sites. Many of the providers are private companies, for example Weight Watchers was a provider for a long time. Another source of data is the referral process, for example from NHS hospitals to community services or from local GPs for the National Diabetes Audit. Someone in the hospital will collect data around this and send it to us. Sometimes we don’t know who actually is doing the work of collecting the data within the clinical setting, for example we get data about the weight changes of patients during a hospital stay, but we don’t know who creates the data. There are some national data collection schemes, for example a form has to be filled in for each hip or knee replacement, which is entered into a national database.

I worked more with the prevention program and something that came up a lot was that there were one or two providers where the data quality was consistently awful. You then waste a lot of time going back and forth with the providers to try and resolve data quality issues. With one of them, no matter how many times we tried to resolve it, we just couldn’t. We just ended up not being able to use most of the data. I think that if it wasn’t a privately contracted provider, that probably would go better, if it was just delivered by actual NHS services in a more standardized way. You just don’t know how they operate, how easy it’s going to be to contact the right person, who is the best person to talk to etc.. There are niggles that are different with each different provider, which means you then have to learn and remember how they operate differently. Or the other way around, if you’re working for Weight Watchers and it’s the first time you’ve delivered something for the NHS, how do you know who to talk to?

But the dependency on the private sector does not only exist when it comes to data collection. Basically all the software and data storage we use is provided by private corporations. Usually we don’t use public or open source software. Of course there are geeks that form organically within NHS England that use or develop software tools that are open source, for example websites like GitHub that let you share your code freely, but no one’s going to be able to access the data itself. So there are those options there for things being less reliant on private organizations. But at the end of the day, we’re using tools like Excel. We are using Microsoft all the time. We’re using platforms delivered by private companies. Health records are usually stored by Oracle. I think where we’d want to get to is investing enough in digital and technology workforces that the NHS can produce its own tooling and software to use and just build on open source tools. Rather than contracting a company like Palantir, while cutting NHS tech jobs at the same time. It’s good that there is a campaign against Palantir, mainly on ethical grounds of not wanting a company that makes money by supporting war and genocide, but it would be an additional dynamic if tech workers within the NHS would say that we want to use tools that give us more control and transparency over our work. 

All this concerned the input side, the sourcing of data. The other question is how much we see or influence the data analysis that we produce. Do we see what happens with the product of our labour? I think that’s pretty good at NHS England. We are involved when changes are made to a program and how it’s delivered. So you do see that it’s concretely improving something. And still it still can be strange having the disconnect, but I think this is just an inevitability of working in a data role really. It can be quite odd spending so much time thinking of people and their individual fates as just records of data. It’s only in certain meetings that zoom out and remember that it’s not about figures, but people. Especially if there’s a clinician on the call as well, they might be telling relevant anecdotes to explain something that we’re collecting or processing data on. It can feel removed while you’re doing most of the work. Because you’re just focusing on the numbers, you calculate things.

I would say that it’s quite a small but passionate and dedicated group of workers that are actually organized within NHS England, but we have launched an open letter. I think that there’s a lot of fear around actually raising your voice about these issues: what happens with job losses and restructuring; what happens to the status of migrant colleagues; who decides what kind of  technology we use and with which corporations we collaborate; what data do we collect and what happens with the data…? If you feel that you can’t even influence that your own job is maybe either cut or transferred over, if you feel helpless about that then it’s very difficult to imagine that you can influence major investment decisions.