The global Microsoft breakdown messed up the shift-booking system for casual ‘bank’ workers at the two main hospitals here in Bristol. Shortly after the respective departments sent us emails that we can’t book any shifts for the moment, we received a text from a friend who works for the post office in Spain: “Guys, nothing works here, how are you doing?”. We experience our global connections as a dependency from an anonymous system – but how anonymous is it really?
A lot of necessary work in the hospital is hidden. Be honest, how often have you contacted the IT department because you forgot your log-in details? Or because Careflow or Bluespear played up? Working together is essential, but they don’t make it easy for us. As workers we manage to cooperate and keep society running through our combined labor, despite all the hurdles that this system puts in our way: the self-interest of individual departments and corporations; the outsourcing and high levels of fluctuation of staff; the precarious and militarized global supply-chains; the irrational hierarchy and bureaucracy; the unpredictable movements of markets and the arbitrary and abstract goal of turning our labor into money, rather than a better life for all. This experience of cooperation against all odds is the basis on which to rethink about an alternative society and the struggle for it. We have to turn our cooperation into real relations of solidarity – between hospital workers and workers who supply us with material, between inpatient care workers on the phone and the IT worker on the other end of the line.
The following conversation with a NHS IT worker took place before the CrowdStrike cock-up…
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I work for NHS Scotland in the digital and security directorate, which provides digital services, some of them through third parties, for example a big contract went to the French provider Atos – yes, the same people that try and make crippled people walk, like Jesus. We provide services to the fourteen regional Boards, which are called Trusts in England. In Scotland these Boards are more centralized, the Board in Glasgow area has around 30,000 employees. In terms of activity, for example we help with ECS, a program that your GP might use to see your patient records. Then there are other programs that all Boards use to monitor the outbreaks of infectious diseases. A lot of my work is to check if third parties, for example software providers, adhere to service level agreements and to coordinate between different departments, for example the infrastructure departments that deal with the hardware side or with the information governance departments. We wouldn’t deal with information governance ourselves, but we would organise that they get in touch with the right specialists. We basically coordinate between the technical and the administrative side, between third party providers, Boards and state administration.
Before that I worked in the IT department of one of the Boards. IT has gone through a change in the sense that previously you used to be visible in the hospital. Someone would phone you and you told them, “Wait, I’ll come down and meet you”. Nowadays most things are done remotely. In my current role, because we are national, we have various sub-departments and user groups. Take the example of ECS again, there are various stakeholders involved, from GPs to ambulances to hospitals. Each board then also has its own patient management systems, but they all have different versions, so it’s a bit of a nightmare. In terms of public departments or private service providers that we work with, as stakeholders they should ideally be treated the same. In comparison with England the process of privatization is lagging behind in Scotland. It’s happening, but at a slower pace.
Previously IT departments wrote their own software and built their own systems, but there’s an economy of scale there. In Scotland they brought a lot of Boards together, in this process they decided not to write their own software anymore, and got private providers to come in. That’s the thin end of the wedge, it makes sense in some ways, but what they ended up getting is pure services. Everything is run like a project now, they offer services for tender and companies offer their solutions, they then get scored and chosen. But then it stops being a project and it has to be integrated into business as usual. That’s where we come in, we represent the business as usual and have to integrate them. In some cases we warned that certain programs shouldn’t go live, because they were not sufficiently integrated into the general network yet, but people on the top decided to do so anyway and it ended up being a disaster. It was already delayed by four years and it is still not fixed. So you save money on the individual project level, but once you have to integrate it, problems occur. That’s similar to all the problems on the railways, where things don’t work together anymore. Those on top didn’t want to put a handbrake on and investigate, because that would seem like the whole thing wasn’t managed well. Then the Scottish Government would come in, because they are funding it all, and start asking questions. Instead they try to push the responsibility on to the outsourced parties and write more and more detailed service contracts, but in the end risks for the entire network cannot be isolated like that. If these firms go bust, there is no one who can manage this thing. You can dump the source code onto a third party, but that costs money and it doesn’t mean that you have the skills inhouse to use it.
Similar to the pandemic, when they developed a new front end track and trace system together with a few small local private companies. They even took it in-house and dropped the private companies, just to bin the program again after the pandemic, as if we might not face a similar situation in the future again.
The thing with Atos, for example, is that they are expensive. They developed a number of systems, I think ECS might be one of theirs. It’s a big contract worth hundreds of millions of Pounds. Working with them is no problem, it is like working with your own IT department. The thing that is different is that you get a formal bill at the end. And it is very well defined what they will and won’t do. For example, the local authorities used to outsource all their IT, because the government said they couldn’t reinvest in the infrastructure. They forced them to outsource. So private companies underbid, get the contract and then increase prices.
That happened at Edinburgh Council where they had 200 employees in IT and they went down to 6, because all they needed was a contract management team. I think the initial bit was 100 million, but by the time it went live it was already 150 million. And when previously you could phone IT to fix a printer or something, now it’s 25 quid just to phone the contractor and 50 quid to replace a cable. That’s the usual story of privatization. In Scotland they have set certain institutional limits to the amounts of profit that private companies can make within the public sector, but that’s part of opening things up.
When it comes to our working conditions, there are the health unions, which in Scotland have a formal place In health service organizations. There are three pillars of governance, one is clinical, one is financial and one is staff governance, which the unions are officially part of. This again gives the employees certain rights, for training or being informed on changes and so on. That sounds good theoretically, but in practice it’s a sham. Even when it comes to little things, like people getting moved from team to team without consultation. I worked at one of the Boards, I was a union rep there. There were two theaters on the site and the union had agreed to two different kinds of working conditions! The staff in one theater had to be on call unpaid, whereas the staff in the other was paid. In our case, management implements a lot of organizational changes, which they should consult people on, but they just call it ‘transformation’. Job descriptions are supposed to be reviewed every five years, but that’s not happening. All this doesn’t only affect your working conditions – if they move you from one place to the other and they do review jobs you might find that your responsibilities have shrunk and you are now on a Band 5 pay instead of Band 6.
Many of us work from home, I go to the office perhaps once a month. We have two big offices, one in Edinburgh and one in Glasgow. That’s another thing of course: the NHS in Scotland used to own their own buildings, but now they don’t, they sold them all off. Now they hire expensive office space. In Glasgow the rent contract came up and management decided not to renew it, but to downsize, as “everyone is working from home” and they thought they could create hotdesks. Now we cannot get into the office because all desks are booked out. They obviously didn’t model it properly. More people work from home since the pandemic, some never returned to office. That can be a good thing, that people don’t have to be stuck in traffic, or pay loads for a cup of coffee. Management complains that it is not good for team spirit, but they might also say that because they have less control over the work environment and suggest that people take the piss.
There are around 30% vacancies in our team, so there is a shortage of labor. Another 30% are only on fixed-term contracts. They are also trying to develop a parallel team to ours, where people are less skilled. We are kind of ‘jacks of all trades’, we do incident and problem management, we develop strategies for the services and so on. What management wanted to do is to atomise these tasks. Every request is now supposed to come through a service portal, if you want a change they will send the business relationship manager to you, he takes the details and then takes it to a project guy, the project guys takes it to a change manager and so on. All this goes on behind the scenes. They think dividing things up this way is more efficient, but we know it’s not.
When we were affected by moving departments it was actually a senior manager who suggested that we put in a collective grievance. As soon as we threatened to put the grievance in the higher up management met and it was clear that they had no clue about what we were actually doing at work. But the union compromise meant that things got sidelined. Management promised to review our jobs, but we just accepted the move. My fear was that we didn’t know the new management and it quickly became clear that they were following a more corporate culture. That was two years ago, when we reached the compromise and management promised to review jobs within six months. Six weeks after the compromise management said that there was too much going on and that there was no time for a review. Our team was pushing and pushing for this. But with the staff governance you get union officers who are paid full-time in their union role, by the NHS. They are called partnership reps. That’s the deal the unions get out of this, free full-time staff for recruitment of new members. These partnership reps can also sit in senior management strategy meetings. They say it’s good to be able to influence things early on, but even the union doesn’t know what is going on, because they don’t consult with their members. In our case the partnership rep said that with the move “there is not much impact here”. We told him: “How can you not see that this is organizational change through the backdoor?! They don’t know what we are doing, giving us extra tasks and de-skill us at the same time”. In the end the partnership rep accepted what we were saying, but also because his department was treated the same way. This is the stage we are at now, we are putting another collective grievance in.
When it comes to the strikes you can see that the Scottish government played things much more cunningly than the English one. In England the government was up for a fight and the union response to that was absolutely pathetic. In Scotland the government was able to settle with most unions by offering a bit more from the beginning. The agreement is still a cut in pay, but not such a big cut. About ten, fifteen years ago we actually had a strike, a one day strike. I was a union rep back then and I suggested taking the IT financial system down, because we controlled it. The union officer nearly had a fit. They don’t care if we walk out for a day, they want to save money and are happy that they don’t have to pay us. But the union guy said “no, no, we are working in partnership here”.
When it comes to IT or so-called tech workers, there is a reputation that they tend to focus on the technical problem and not on the social dimension of the problem. I have worked for banks and multinational corporations, but I would say that IT workers in health have the attitude “our work is for our colleagues at the coal face”, the so-called front-line staff, and what we do is to make it as easy as possible for them. That’s a common theme, but there is a kind of breakdown if you go up the hierarchy. Up there it’s all about cost and “we can only go so far to support front-line staff”. The general attitude is a ray of hope though. We have to find ways to relate to this. The other day I went to the Troublemakers conference and on the day I thought “this might have something”, from NHS Workers Say No to other groups, and I thought, “let’s get a real rank-and-file network going”, but now they want sponsoring from the main trade unions rather than actually doing something. That’s gone, we need something new!
